The purpose of this essay is to discuss, within a case study context, the impact of severe mental health problems on a client whose care I have been involved in and, to discuss how the condition has affected the person, their informal carers, family and supporters. This essay will aim to provide an explanation of severe mental illness as well as an overview of the chosen client’s background, diagnosis and the impact this has had on them and those involved in their care. To protect the identity of the client and to respect the principle of confidentiality, a pseudonym has been used throughout this essay (NMC, 2008).
The reason for choosing John for my case study is that having worked with him for approximately 2 years now, I feel I have already developed a therapeutic relationship with him. Having this Therapeutic relationship means there is an ongoing rapport resulting in John feeling at ease in disclosing personal information..
There is no universal understanding of what a severe mental health illness is it tends to be seen differently by the person experiencing it, their family and doctors. The term can refer to an illness where psychosis occurs, e.g. Schizophrenia; it also includes mood disorders, e.g. manic depression, schizoaffective disorder and clinical depression, and often referred to severe mental illness Psychosis describes the loss of reality a person experiences. (Rethink, 2009).
This case study is based around a 24-year-old man who shall be referred to as John. John has been diagnosed with paranoid Schizophrenia first diagnosed in 2003. Since receiving his diagnosis he has had several admissions to hospital as well as being involved with the judicial system due to the fact that he made threats to murder his father. Although these charges were dropped. John is currently detained under part two of the Mental Health Order (Northern Ireland) (1986).
Schizophrenia is a major psychiatric disorder, or cluster of disorders characterised by psychotic symptoms that alter a person’s perception, thoughts, affect and behaviour. Such symptoms will be individual to each person’s experience. Typically there is a prodromal period often characterised by some deterioration in personal functioning. This includes memory and concentration problems, unusual behaviour and ideas, disturbed communication and affect, and social withdrawal, apathy and reduced interest in daily living. These are known as negative symptoms. The prodomal period is usually followed by an acute episode marked by hallucinations, delusions, and behavioural disturbances. (National Institute for Health and Clinical Excellence, NICE, (2009).
As fore mentioned John has a diagnosis of chronic paranoid schizophrenia. This is characterized by positive symptoms, such as visual and auditory hallucinations, which currently John is experiencing. These are known as a perceptual disorder, when the person perceives things differently from others (Block3, Unit 14). People who experience schizophrenia may be distressed and have problems communicating often displaying bizarre like behaviour, apathy, and reduced interest in daily living. These are known as negative symptoms.
Craig (2004) advises that paranoid schizophrenia is a subtype of this disorder characterised by a domination of persecutory delusions and hallucinations in the client’s i.e. Johns symptoms.
John’s illness has had a large impact on him and his family from being diagnosed in 2003. John’s diagnosis of schizophrenia has affected both him and his family psychically, emotionally and socially. Physically John’s illness has affected his motivation as he has been isolating himself in his bedroom for long periods of the day and has been complaining of insomnia, John has often said to me that voices are sometimes too intense for him to deal with resulting in a poor nights sleep.

John also hears voices, which are of a persecutory nature making derogatory comments such as “He is a liar” “he cannot be trusted” causing him sometimes to respond out loud. This can cause John to become aggressive and distressed with increased anxiety levels. This has prevented John from making and maintaining friends. His behaviour can be frightening to those who do not understand how this particular type of mental illness can affect you.
John appears to have difficulty in structuring his day due to the levels of anxiety caused by the derogatory voices he experiences. This is impacted upon both his positive symptoms and difficulties in concentration. John’s paranoid ideation impacts on his ability to cope in day-to-day situations.
The level of severity and impact on functioning may vary to such an extent that some individuals function relatively well in society whereas others become severely incapacitated. (Ryan, 2008,cited in Barker)
The Multi Disciplinary team (MDT) in my workplace have put several interventions in place to promote John’s motivation to engage in his daily activities, either on a one-to-one basis or in-group activities with fellow patients. This will help engage and develop his relationships with fellow patients and staff, and hopefully will improve his behaviour on and off the ward. John has agreed a programme of therapy with the occupational therapist to engage in cookery sessions with no more than three participants.
Life skills, or Daily living programmes provide group or individual training in ordinary social survival and include teaching and supervised practice in financial management and domestic skills such as cooking, cleaning shopping, and allied consumer skills, such as complaining. (Psychiatric and Mental Health Nursing, p223). John’s family have attempted to learn how to cope, adjust and come to terms with his illness. John’s illness has had a large impact on his family throughout the years Johns father was the potential victim of John’s paranoid ideation. This has caused division within the family unit with, Johns mother emotionally in conflict between her relationship with John and her husband. Johns MDT has engaged in family work to recognise and resolve these issues, and with Johns consent I have been attending the above meetings and have been closely with my ward mentor.
It has been said that those with family members with schizophrenia experience considerable stress, there often pain and puzzlement about their relatives behaviour and obvious distress, often families self – blame (Barker 2009). Initiating and maintaining a therapeutic relationship is paramount in engaging with John and his family.
There are many assessments carried out on a daily basis monitoring Johns mental state, mood, level of functioning, medication concordance, distress from symptoms. Regular reviews also take place through the forum of the weekly Multi Disciplinary Team meeting (MDT). The MDT meetings are attended by all professional who are involved in johns care, including a Consultant Psychiatrist (responsible for decision making and co-ordinating the patients care and choice of which medication would be best for him), a Psychologist (responsible for individual programmes tests, assessments) a Pharmacy representative (responsible for safe prescribing of medication), Occupational Therapist (responsible for sensory and physical needs before and after discharge), a Social Worker (responsible for the signing of mental health forms where required, individual work and social history work), and Nursing staff (responsible for providing information of patients progress over the last week, putting forward any requests on behalf of the patient, and assessing success of treatment of care/care plans.
Although Johns mother and father have been very supportive towards him, visiting him as often as they can even though the family home is approximately 180 miles from the hospital, Looking after his finances and taking him on day trips and walks at the weekend. John’s family, often supply him with money, coke, cigarettes and whatever else he may need.
Nevertheless, John’s family continue to be a significant social support to him and the facilitation and integration of his family is fundamental to ensure the promotion of his recovery. NICE recommend that carers. Relatives and friends of people with schizophrenia are important both in the process of assessment and engagement, and in the long-term successful delivery of effective treatments. This guideline uses the term “carer to apply to everyone who has regular close contact with the person with schizophrenia, including advocates, friends or family members, although in some cases family members may choose not to be carers. (NICE, 2009)
Psychological interventions offer family intervention to all families of people with schizophrenia who live with or are in close contact with the service user. This can be started either during the acute phase or later, including inpatient settings. (NICE guidelines 2009)
Modern psychosocial treatment aims to help patients overcome social barriers, including the stigma that is often attached to schizophrenia. Comprehensive care for schizophrenia comprises a holistic package, which should include cognitive behavioural therapy, family interventions, supportive education and life social and vocational skills training. Many of these are incorporated into THORN and psychosocial interventions. (PSI) training courses, and should be integrated into basic mental health nurse education programmes.
Thorn is a model of best practice for working with people with a diagnosis of severe mental illness and has existed for nearly twenty years. THORN strengths are its ongoing responsiveness to contemporary models of mental health care, which ensures that the curriculum is aligned with current health and social care policy. The outcomes and competences expected through successful completion of a THORN course reflect current mental health strategies for all four countries of the United Kingdom. These include New Horizons, A new vision for mental health and well being England (2009) Delivering the Bamford Vision; Action Plan for Mental Health illness and learning Disabilities services for Northern Ireland (2009). Delivering for Mental Health, The Mental Health Delivery plan for Scotland, (2006). Raising the Standard, the revised NSF for Mental Health for Wales (2005).

References
Barker P (2009), Psychiatric and Mental Health Nursing: The Craft of Caring; Edward Arnold LTD; 2, London, Hodder Arnold.

Craig, T (2004) Severe Mental Illness: Symptoms Signs and Diagnosis. In Gamble, C and Brennan, G (Editors)(2004) Working with Serious Mental Illness: A Manual for Clinical Practice, London; Bailliere Tindall. Pp. 41-44.

The Nursing and Midwifery Council (2008) The Code: Standards of Conduct, performance and ethics for nurses and midwives, NMC London.
Nice guidelines 2008
O’Carroll, M., Rayner, L., and Young, N. (2004) Education and training in psychosocial interventions: a survey of initiative course leaders. Journal of Psychiatric and Mental Health Nursing, vol (11) pp. 602-607.