Health assessment and clinical manifestations mental illnesses developing paralytic illeius
A person’s mental health is critical in living a full life because mentality is the capacity of the mind to know and understand. The disruption or the illness of a person’s mentality therefore is a disruption of his supposed living. The person is unable to function properly for himself, his family, nor in the society. Some types of the mental illnesses are curable and others, recurrent but manageable.
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Mentally impaired persons are often stigmatized. This could greatly be accounted by the wrong and sometimes grotesque perceptions of the illness. Labels like ‘crazy’, ‘possessed by the devil’, ‘insane’, ‘abnormal’ and ‘lunatic’ are only some of the negative identities that are instantly linked to inflicted persons. Because of these, many people fail to seek out help in fear of being labeled as crazy and perceived as not to be trusted, dangerous or capable of violence. Fear of being society’s outsider is one of the most common reasons why people with mental illness go undiagnosed or untreated and in most cases diagnosed when it is too late to manage or treat the illness.
The fact is, the majority of mentally impaired persons are neither criminals and are never violent. Those few who are violent get publicized in various ways in the television and movies; resulting to a negative perception of all mentally ill people. These also often become a basis for determining legal proceedings for mental health issues. The sad part though is that although some of the portrayals are accurate or realistic, some are more likely sensationalized. This results to the majority of the people being ignorant on the true nature of mental illnesses.
Legal Compulsion for Assessment and Treatment for Mental Illness
Mental illnesses generates a lot of issues for the inflicted and his family; issues pertaining to legal, social, ethical and clinical aspects of the mental disorder. With this fact, government systems have infused in their health care systems laws for people having mental illnesses.
The Mental Health (Compulsory Assessment and Treatment) Act 1992 in New Zealand sets out procedures for the compulsory assessment and/or treatment of people who are or may be suffering from a mental disorder. Compulsory assessments can be made when a medical practitioner considers that there are reasonable grounds that the proposed patient is or may be mentally disordered. Another is if the Court believes that the proposed patient is mentally disordered (ADHD.org.nz).
Under this Act, the accepted patient is required to take either community or inpatient treatment arranged by suitable professionals defined in the Act. A patient who is subjected to a compulsory treatment order is required to accept such treatment for mental disorder as directed by a responsible clinician for the first month treatment at the current time of the compulsory treatment order and afterwards, if a psychiatrist appointed by a Review Tribunal considers that the treatment is in the patient’s best interests. In all other cases, the patient’s informed and written consent must be obtained, and may be withdrawn at any time (Guidelines to the Mental Health (Compulsory Assessment and Treatment) Act 1992, 2000).
The Act further defines the rights of such persons subjected to the compulsory treatment order and provides better protection for their rights with the gradual reforms and consolidation with the laws pertaining to the assessment and treatment of persons suffering from mental disorder.
In this paper, the situation of a probable candidate for the compulsory treatment order will be discussed from a Mental Health Support worker’s point of view. Mental Health Support workers have the responsibility to work with people who have severe and enduring mental health problems who live in the community. Their focus is on the whole person, including their social circumstances and they establish their support by maintaining a close relationship with the person.
History and Present Circumstances of the Probable Patient
Richard is a Pakeha or a white European man in his early twenties. Following his high school education, he went to university. In his second year of the undergraduate degree, he was diagnosed with having Bipolar disorder. For three years, he has not regained his equilibrium. He has tried to maintain his studies, but frequently not completing his paper or requirements. Richard has tried using the counseling services available, but they were unable to help him accept his mental illness and to establish good self management. He doesn’t feel comfortable taking the prescribed medicines for Bipolar disorder; Lithium (mood stabiliser) and antipsychotic medication makes him uneasy when he takes them. Clearly, he has not accepted that these medications are substantial for his health and beneficial to continue his life. At the present, he is drifting to the edges of society and still refuses psychiatric services.
Richard is finding people who are rebelling against authority, real or imagined. He is firm on his belief that psychiatry has the wrong interpretations of his experiences. Richard sees himself as unusually gifted and talented, which is supported by the people that he is mingling with.
Despite of this, Richard knows and sees that he is becoming more and more unsystematic in his actions, thoughts and verbal communications. One instance is that he has convinced WINZ (Work and Income of New Zealand or Social Welfare Office) to fund him in setting up several flats over the past six months. This originated from his desire to have a secure home. WINZ has said that their funding for him stops there, but recently, he has again settled with the office to be financed into having a flat. Richard stayed for only four days in the flat.
Despite his constant denials of his illness, he has reached out to an acquaintance (John) who is a political activist that has deep compassion for people wronged by the structures of society. John, also a Pakeha and in his late fifties/early sixties, could be seen too around the edges of the society. Unlike Richard, he embraces society to help change for the betterment of the ordinary people and change unjust systems.
John would like to find an effective way and asks advices to help Richard. John has no confidence in the CATT (Crisis Assessment and Treatment Team) team. Like Richard, he also believes that he will be only given more drugs that will stop him from studying and realizing his talents. Richard is not willing to go to the General Practitioner for fear of being referred to the CATT and be held against his will under the Mental Health Act. Richard assures John that he is taking his medications but given his condition, this is unlikely.
When asked about Richard’s condition, John says that he is disheveled and has an offensive body odor. It looks like he has not shaved and cut his hair in a long time, and John adds that Richard does not look unusual given the current fashion for growing beard and long hair. When John offers him food, Richard grabs them and stuffs it quickly into his mouth, as though he is very hungry.
John describes Richard as having increasing paranoid thinking, but does not think that Richard has thought of acting violently towards those he has paranoid thoughts about. John is not concerned of violence but this in contradicting to his strict guidelines for Richard when he wants to see or contact him. He has given Richard firm rules on what time he can call him at home. In addition, Richard cannot talk to John’s wife and must not turn up at John’s house without forewarning.
Based in his current situation and history, it can be seen that Richard is a probable candidate for the legal compulsion for assessment and treatment under the Mental Health Act 1992. The following discussions will explain why this is so.
Why Richard should be under the legal compulsion of assessment and treatment
Bipolar disorder is one of the most disabling mental illnesses known to man because it is recurrent. Many factors act together to produce the illness. Inflicted people “experience periods of mania or hypomania, depression, and ‘mixed episodes’ or ‘dysphoric mania’ (both manic and depressive symptoms)” (Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Bipolar Disorder, 2004). Due to its recurrent nature, the highly advised treatment is a combination of pharmacological treatment and psychotherapy.
During episodes of depression, people with this psychiatric condition are most at risk of suicide. Other risk factors are expressed intent, previous suicide attempts, hostility, poor social support, delusions and/or hallucinations, history or presence of mixed states, family history of suicide, personal and/or family history of violence, short latency from illness onset, poor medication response or tolerance and significant personal and interpersonal vulnerability (marital tension and poor self-esteem) (Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Bipolar Disorder, 2004).
Richard’s mental illness and his current living situation should be given focus here. He is assumed to be living alone independently with no known immediate family nearby. He is already at a high risk of committing suicide given his living conditions. From John’s description of Richard, he has been discarding basic hygiene and nutritional needs for himself, how much more of his medications (although he assures that he is taking them). His continuing paranoid thinking and unkempt appearance that John talks of is a suggestion that he has not been taking his much needed medicines. One major reason could be anosognosia or lack of awareness of his illness. Lack of awareness of illness is the single most important reason for nonadherence with medications and is one of the most serious problems in psychiatric care (“Why Individuals with Schizophrenia and Bipolar Disorder Do Not Often Take Their Medication”). From all the other reasons of nonadherence to medication, another reason that can be related to Richard’s condition is purposeful stopping of medication because as he says and believes, the medication will only make him stop studying or realizing his supposed talent or it could be that he likes or enjoys the feeling of being manic.
Richard has reverse beliefs on what should be done to help his situation which is portrayed on his continually refusing psychiatric services and adverse perception of taking his medications. The varied nature of Bipolar Disease requires a broad range of interventions (Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Bipolar Disorder, 2004). Richard’s apprehensions can be alleviated if he were aware of the nature of his illness. By joining support groups for people with Bipolar Disorder, he will be able to interact with other people in the same situation as he is and it will perhaps lessen his fear of involuntary commitment.
Peer Support is an intentional form of social support that may help individuals to develop new perspectives on one’s illness and access information, including specific training (Bristol F., Doughty C. and Tse S., 2004). People with Bipolar Disorder sometimes find support, acceptance and comfort in discussing their experiences with other individuals who have experience of similar illness in peer support or mutual-help groups. Affiliation and connection is important in understanding and Richard may benefit highly if he were to join these groups which are quite abundant in New Zealand.
Richard could be encouraged to join these support groups through John, who is at the moment can be considered as his most trusted friend. John also has to understand that what Richard’s illness requires is for him to take medications and psychiatric consultations to manage the consequences of his illness and thereby helping him in the process of living well as much as he can. Richard may have repeatedly denied that he needed the help of professionals, but it can be seen by the fact that he reached out to John that he unconsciously does believe that he needs all the help he can get.
Bipolar disorder can be disabling that work becomes impossible, like in Richard’s case; he could not meet requirements and papers in the university. Therefore if he goes untreated, he will continue to add up to all the other people that continually is applying for and receiving Social Security Disability benefits from the government. Furthermore, since bipolar disordered people need constant medications and frequent visits to the doctor, soon issues of insurances then arises. If one does not have insurance before diagnosis, the disorder is labeled pre-existing.
Bipolar disorder does have tendency of violence since the disorder can lead to psychosis. Like in the case of Joseph Palczynski, who was earlier diagnosed of having bipolar disorder, “went on a crime spree on Tuesday, March 7” year 2000 (Read K. and Purse M., 2000). All in all he had murdered three people that day when he allegedly kidnapped his ex-girlfriend; two were the couple that his estranged girlfriend was staying with and a bystander who was trying to help. His lawyer described him as “a very personable, likeable guy but has this emotional problem that from time to time, pops up.” Mr. Palczynski even said that he was like a bomb waiting to explode and blamed it on the reduction of the lithium that he had been taking to treat his bipolar disorder. This example is one of the extreme situations when a person with bipolar disorder has been treating himself in the wrong way or in an abusive way.
If he were to be proposed as a patient under the Mental Health Act 1992, his assessments, treatments and developments would be highly monitored by responsible appointed professionals.
It is important to see the Act as not only a law to protect mentally disordered against themselves and others but a means of civic approach in helping inflicted citizens in finding a sustainable life despite their mental illness. In addition, his family or relatives, if there are any, would be required to be informed and involved of his treatment order under the Act which is undeniably vital for his restoration. Consequently, he could receive community treatment orders as supposed to inpatient treatment, so that he can be treated for his mental disorder and at the same time be comfortable with the monitored freedom that he gets.
Richard is only on his early twenties, still with a lot of potential to live a somewhat full life if he can learn to manage his mental disorder. With the Mental Health Act 1992 he can probably restore a more satisfying life with the prophylaxis (in collaboration with drugs) psychological treatment of bipolar disorder best begun when the patient is relatively well. At the present situation, Richard has only these options, one is to go on denying himself the help he needs which is definitely going to lead to his destruction, or he could fight for his life and accept the help offered or in this case could be required of him.
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<http://www.adhd.org.nz/Medlaws.html> Accessed May 21, 2007
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<http://www.psychosocial.com/IJPR_9/BiPolar_Pilot_Study.html> Accessed May 21, 2007
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Accessed May 21, 2007
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