What context worked with S/U?

Family, Social & Personal History

The 3500 word essays needs heading, table of contents as indicated in bold (exclude numbering). Section 2, is a summary of service user (s/u) background/history. Please use the information I have written to go towards this. Then on a separate page, this will be Appendix A please complete the case study 500 words.

1. Introduction – 150 words

Main aims and objectives

What are you going to explore?

Confidentiality clause – using NMC Code and Data Protection Act. Name has been changed to Rosemary.

2. Service user’s (S/U) background – 150 words

on S/U then see Appendix A

What context worked with S/U?

See initial assessment – demographic details, social, mental and medical history.

Presenting mental/physical problems

Associated risk

Rosemary was admitted to the acute female ward on an informal basis. The referral was made by Rosemary’s GP after a routine appointment where Rosemary disclosed that she was unable to care for her young children and expressed ideations of suicide.

Family, Social & Personal History

Rosemary has two children, Jacob, aged 9 and Charlotte aged 7 who are currently being living with their maternal grandparents since her admission.

Rosemary is 35 years old who has separated from her husband six months ago. Rosemary said that he blames her for the breakup due to her erratic behaviour including her inability to stop spending. Rosemary admits that despite their good income, she has had to remortgage their home three times to cover her spending. Rosemary feels guilty and scared with ‘no way out’ as they can not longer afford the mortgage repayments and have had final demands from the mortgage company and face eviction.

Rosemary has expressed she is unable to cope with her life, that she’s ‘a terrible mum’ and that the ‘children would be better off without me’. Rosemary has not taken her medication for five months. She was able to regulate her emotions and be overly happy, overly anger and tearful most of the time. She said the only reason she is able to keep her head above water is the CBT treatment she has had in the past.

Rosemary was a Teaching Assistant at a nearby secondary school for 15 years, however she stopped going to work five months ago. In the past her employers have been very understanding with the amount of time she has been off sick due her mental ill-health but Rosemary feels ‘I can’t keep letting them down’ and therefore she has no plans to return to her job in the future, although the school have offered to keep her position open.

Rosemary was born in London. She has two younger siblings, Russell, 33 years and Duncan, aged 30. Both her parents grow up and studied in Ireland before they came to England to start their nursing careers. Rosemary and first brother went to leave with their maternal grandparents from the age of two to six but she cannot recall anything from this period and is unsure the reason why she moved. She said that she has a very loving family, although she would often get into arguments with her mum growing up.

Rosemary left school with 9 GCSEs but felt she could have done better. She went onto Exeter University to study teaching, where she met her first boyfriend. Rosemary referred to him as ‘lovely’ but finished the relationship after 10 months as it ‘didn’t feel right’. After the split, Rosemary admitted to ‘going crazy’ as she started taking recreational drugs and sleeping with multiple men, which on reflection Rosemary thinks it out of character. Into her third year, while Rosemary was visiting her parents she detained under Section 2 MHA. She remembers ‘hearing voices’ and being told later (by her parents) that she was ‘having a conversation with television’.

Rosemary remembers trying to leave the ward and being restrained face face by a group of men ‘as they pulled down my trousers and injected my bum’. She was further detained under a Section 3. After spending 4 months on the ward she was discharged into the care of her parents. Rosemary advised she stopped taking recreational drugs, however sequentially confirmed she has two further informal admissions but was unable to provide further information. ‘I had years of feeling great, going to the gym, meeting friends for coffee and holidays, partying all night and periods I felt lonely and didn’t go out’ and as a result ‘lost all my friends’.

Rosemary had several jobs in retail as she enjoyed interacting with customers and helping them. However, she was unable to hold down a job for long and feels like a failure. Rosemary even commented that ‘my family think I’m useless’. She said that she always felt just as she was ‘doing really well, I would just stop going in’. In hindsight Rosemary thinks it’s a form of ‘self-sabotage’ but does not understand why she behaviours like this. She thinks this applies to her relationships too.

Presenting Mental Health

Rosemary appears low in mood and cannot the last time she felt enjoyment (anhedonia)

Worthlessness

Thoughts of death

Poor concentration

Self-neglect

Mental Health History

Section 2 at 24, further 3 months on Section 3 with drug induced psychosis

Formal admission 6 moths later for 2 months

2 years later, formal admission for depression

Diagnosed with BAD 5 years ago.

Current Medication

Lithium 1000mg

Quetiapine 100mg

Lamotrigine 75mg

Forensic History

None

Physical Health

Except for symptoms of depression, Rosemary is healthy.

Views of carer

Mother is very aware of her daughters episodes and can see changes before Rosemary. Mother was the one that actually that suggested Rosemary may have BAD over ten years ago.

Associated Risk

Medication – stopped

Suicidal ideation, Think about, Made plans, How, Means

Safeguard self and children