Patient-Centered Mental Health Care

Introduction

The health and social care professionals focus on maximising the quality of care to treat the patient efficiently and provide the best treatment and care in so that the individuals can overcome the health issues and mental illness (Horgan et al., 2021). The aim of the essay is to develop therapeutic relationship for building trust and respect among the patient and develop good care plan for maximising the wellbeing of the individuals. Through this study, it is possible to develop the relationship with the patient as well as discuss the therapies suitable for the patient. After evaluating the therapies, it will provide a scope to choose the best therapy for the patient Adam, so that it would be possible to maximise the standard of living of the individual. Adam is a 35 year gentleman suffered from mental illness with the experience of attacking on his neighbour and he experienced this five years ago. He is referred to the community mental health team to support him and provide good therapy to overcome his mental illness. He has the medical history of physical abuse by his father and attack from the strangers. Adam is struggling with a post-traumatic disorder, and phobia of being in a crowded area or around young boys wearing hoodie clothes. After his neighbours attack, he had not been able to work and going out almost three months now and he has also been reported issues with hearing voices. It is important to help Adam for overcoming his mental issues and support him to lead a normal life.

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Explore a therapeutic relationship with a specific mental health service-user

Therapeutic relationship refers to the relationship between a health care professionals and the client in order to provide the best threat after patient diagnosis through engaging the patients and develop suitable care plan for maximising the wellbeing of the individuals. As per the Nursing and Midwiferies Code of conduct, it is important to maintain patient confidentiality to deliver the best quality care by ensuring patient centred care (Beattie et al., 2019). Therapeutic relationship is hereby crucial for the health care providers to empower the individual in developing good therapeutic planning. As a health care nurse, it is essential to identify the aspects of the mental health care which are treatment, therapy, and intervention planning for prevention, health education and promotion in the society for increasing the quality of life (Hartley et al., 2020). Hence, nursing professional is playing an important role to engage the social communities and improve internal communication and cooperation for therapeutic relationship development. In order to support Adam, I try to utilise communication skill, both verbal and non-verbal, so that it would be possible for me to interact with Adam and understand his needs and preferences. As per NMC, it is essential to enhance communication for patient engagement and empowering them in developing good therapeutic intervention plan. It has to develop patient centred care which is another NMC code where listening the patients, understanding their mental state of mind, trusting the patient with value and respect, prioritising their needs and fulfilling their preferences through developing good therapeutic intervention planning (Morant et al., 2021). During my first meet to Adam, I tried to introduce myself with positive body language, good communication, politeness and showing respect and empathy to Adam, it further helps me to interact with home and develop good bonding with appropriate eye contact. Genuine interest to listen his preferences and understanding his mind set. I always try to develop good conception with Adam through open communication and discussion, where I focus on developing friendly atmosphere so that Adam can cooperate with me and share his thoughts and perception towards the issues of mental illness and past incidents in his life.

For developing therapeutic relationship, it is hereby mandatory to develop good communication and bonding, so that the individual can trust the health care professional and cooperate with them for getting the best treatment and psychotherapy (Turner, Brown and Carpenter, 2018). I always respect Adams decision and choice where I always empower Adam and ask him about the perception and activities that he wants to do. Positive body language including clenching, pacing, freezing during the conversation and personal space is also helpful for me to support Adam and let him speak about his needs and preferences. He is suffering from trust issues and threat of at being attacked in the society, where I try to improve his self-esteem and self-actualisation so that he can feel confidence and protected in the society. On the next visit, I develop open questions so that Adam can answer and improve bonding with me for further intervention planning. I always respect Adams decision and try hard to fulfil his needs and personal preferences. He gives me the opportunity to understand his feelings and he starts communicating with me positively for sharing his personal emotion and feelings. He shared the fear of accessing the social community for which he is struggling from social isolation. Through verbal communication, I try to pay attention to Adam speech and through nodding my head, maintaining good eye contact and ensuring facial expression with smile and empathy; it is helpful for me to develop good therapeutic relation with Adam. I was mindful of the tone of my voice when interacting with Adam and I did not show sympathy rather I try to understand his problems and cooperate with him to become confident in communicating with the social communities. I also create friendly environment for developing trust and bonding with Adam, and on the next meet with Adam, he starts discussing about the recent pandemic situation of COVID 19, where he is suffering through financial difficulties to pay the bills and mortgagees. At that time, I also share my financial difficulties in such critical satiation, and also provide advice to access some resources including mortgages, holiday and universal credit.

I maintained non-judgmental attitude and allowed his feeling of guilt and low self-worth were adequately voiced. I carefully pointed out different resources to deal with his anxiety and phobia, so that he can overcome the illness and interact with the social communities positively. During my next visit, I try to discuss some therapeutic plan, for anxiety management and phobia where I am successful to prepare him for further therapy. I share all the information about the therapy with Adam so that he can trust me and cooperate with me for attending the therapeutic intervention planning. In this context, I also told him about the medics, care coordinators, psychologist and therapist who can call him for improvement of his state of mind. Hence, the major strengths are good communication skill, cooperation and internal bonding, listing and sharing the information, supporting Adam, as well as helping him to socialise. The major barriers during the therapeutic intervention are lack of good routine in life, disrupts in sleeping routine and in this context, I tried to prepare him for the therapeutic appointment by sleep management, as good sleep is healthy for mental condition. I shared the information about good sleeping which has positive impacts on physical and mental health and I also help him to inform about not using any chemicals that disrupts sleeping such as nicotine, caffeine and alcohol prior to bed. Daily exercise and light meals at night are also effective habit as well as taking hot shower or bath before going to bed at night and reading are also beneficial of sleeping. Hence, I try to develop therapeutic relationship with Adam by sharing information, advising him to stay healthily, cooperating and communication with him, respecting his decision through empowerment and managing integrity in therapeutic intervention.

Range of therapies that may be suitable for mental health service-user

The major three therapies for Adam are such as psychodynamic therapy, person-centred therapy, Exposure Therapy (Trivedi, 2020). These three therapies are available to treat the patient with anxiety and phobia and it will be beneficial to discuss the therapeutic intervention planning to support the patient with mental illness.

Psychodynamic therapy

It is generated from psychoanalysis of Freudian psychology, focusing on identifying the psychological issues among the human being in order to improve self-awareness in the resent situation, where the therapies will review the early life experience, emotions and thoughts and beliefs of the individuals (Johanna et al., 2021). Through communication and cooperation with the coordinator under this therapy, it becomes easier for Adam to understand the childhood trauma that has impacts on his resent difficulties. Short term treatment of depression, anxiety, and increased the symptoms of phobia, behavioural abnormalities and eating and sleeping disorders are possible under the Psychodynamic therapy (McPherson et al., 2018).

Strengths

The Psychodynamic therapy is beneficial to treat the patient with anxiety and depression. It is hereby advantageous to treat Adam with quality care and continuous support. Lots of emphasise on childhood activities is another strength of this therapeutic planning, where the individuals can understand the issues and memorise the childhood experience, so that the coordinator can support them to overcome the issues (McPherson et al., 2018). Through this therapy, interpersonal relationship with Adam can be developed where it is beneficial in building their confidence, establishing potential space for complimentary, gain insights into other interpersonal relations and enhancing hope.

Limitations

The process of Psychodynamic therapy is lengthy and thus it may become difficult for Adam to attend twenty session of the therapy continuously. Lack of cost effectiveness, high recovery time and risk of drop out as well as unusual application of Psychodynamic therapy are the major limitations, where the patient condition may be deteriorated in long run.

Person centred therapy

Person centred therapy focuses on the unique experience and capacity of self-actualisation and self-esteem of the individual rather than identifying their symptoms. According to Carl Rogers, it is beneficial to develop effective care plan for supporting the individual and overcoming the mental disorders. Supportive environment can be created under this practice where NMC code and NICE guidelines also support to develop Person centred therapy with acceptance and empathy (Santos and Cutcliffe, 2018). Present state of mind of Adam and recognising the solution through empowering Adam in care plan is possible in this therapeutic planning where the skill set active listening, non-judgemental practice, continuous communication and cooperation, clarifications and reflections help Adam to cooperate with the care givers and manage the mental illness of anxiety and phobia.

Strengths

It is a recovery treatment which is beneficial for Adam to overcome his thoughts and phobia and maximise self-actualisation and esteem. It also provides a scope to involve the patient and develop collaborative therapeutic intervention planning (O’Keeffe et al., 2018). Adam can participate in the treatment and therapy process and share his personal opinion for better management acceptance, empathy respect and genuineness are also the factors that improve the quality of person centred therapy, where care givers can promote client values and maximise his preferences in long run. Openness, building rapports and engaging with Adam are also the advantages of developing this therapeutic planning. It is hereby beneficial to overcome stress, depression, anxiety and phobia where it is possible to balance between the idealised and actual self. It strengths trust in self and others and also provide a scope to achieve better self-awareness. It also reduces the feelings of guilt and insecurity and sustains healthier relationship. Hence, it would be beneficial for Adam to get person centred therapy for managing his stress and mitigating phobia that will improve social bonding and relationship.

Limitations

The major limitations of the therapy are lower dropout, recurrence and relapse rates on common mental health issues where there is no such intervention techniques to support the individuals (O’Keeffe et al., 2018). Subjective experience can give too much stress to the patient and it is also not scientific approach to the patient. It increases the personal and financial cost as well as exclusion of certain groups, exclusion of staff personhood and risk of compassion fatigue is some limitations of person centred care in the therapeutic intervention.

Exposure therapy

The exposure therapy refers to the practice of systematic confrontation of feared stimuli, such as feared objects, activities, situations) or feared thoughts, physical sensations). It is mainly utilised to treat PDST, phobias and anxiety Originated from the idea of classical conditioning of behaviourist (Baumgardt et al., 2021). It is also possible to ensure systematic confrontation of fear-eliciting stimuli and aims in creating a safer environment to challenge problematic fears. This approach is beneficial for Adam in order to acknowledge stressful stimuli instead avoidance or escape. It is also helpful to support Adam to overcome and face the fears in the society in order to improve self-esteem and actualization.

Strengths

It promotes the treatment and care for the patient suffering from mental illness such as anxiety, depression, stress and phobia. It is beneficial to challenge the fear and improve the mind-set of the person through therapeutic intervention.

limitations

I shared the information about the fact that, there can be some barriers affecting the accomplishment of this approach, which includes refusing treatment or dropping out due to the exposure of most feared stimuli or you can find it distressing. Adam is optimistic to engage with this approach for overcoming his phobia and depression. This therapy is concerned about tolerability and safety of exposure appears to be a major reason for underutilized.

Discussing chosen therapy that is the most helpful for the chosen service user

Exposure therapy is a technique of behavioural therapy for treating anxiety disorders where it involves exposing the target patient to the anxiety sources or its context without the intention to cause much danger. It is also referred as a cognitive restructuring, exposure based on the cognitive therapy. It involves practical and directive behavioural component that is essential to treat phobia (Pickard, Rodriguez and Lewis, 2017). Exposure based homework assignments are helpful in this regard to improve client activities about the next session. Social anxiety and depression are the major issues in Adam and the exposure therapy is considered to be the most effective intervention planning to treat Adam with continuous cooperation and communication. Exposure based treatment and therapy through adopting new strategies are helpful to support Adam to expose the past activities and mitigate the impacts of the experience in the resent situation. It is hereby the best therapy for Adam where he can mitigate the fearful reaction to the stimulus, by improving symptomatic and functional outcomes in near future. The approach mainly empowers Adam to discuss the stimulus and overcome the fear by accessing the social communities independently. The mental disorders of the patient are mainly related to the stimuli linked with the childhood trauma. It further hampers cognitive patterns, raise difficulties in emotional regulations and increasing emotional activities to threat. Adam mainly has the childhood physical abuse by his father and a physical attack, and it is a main stimulus which affect the adulthood of Adam.

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Knowing the extent of avoiding situations and positive emotions is crucial for understanding the factors of anxiety and phobia (Pickard, Rodriguez and Lewis, 2017). Information sharing, showing empathy and increasing social activities through homework and exercise further protect Adam to feel safe and interact with others independently. During the process, Adam will be taught to how to recognise habits of worries, rumination, overgeneralisation and avoidance. Apart from that, continuous cooperation and identifying the issues, discussing Adam's perception and his preferences will support him to overcome the challenges and manage anxiety and phobia. It also helps to improve non-judgemental attitude and increase positivity and optimistic thoughts among the individual (Beck, 2019). Relationship between therapeutic outcome and self-efficacy further help Adam to overcome the issue of anxiety and phobia through this therapeutic practice (Chaidemenaki, 2021). Through continuous cooperation, information sharing, increasing Adam's participation, social bonding and independent interacts across the social communities is helpful in this therapeutic intervention planning to support Adam and mitigate his mental illness. Hence, the exposure therapy is suitable for Adam to stay healthily and improve activities in the society, where Adam feels protected and safe in interacting with others that further provides a scope to overcome the issue of anxiety and phobia. Through intervention, rewarding with brave behaviour, continuous motivation and developing self-esteem further provide a scope to Adam to feel special and work efficiently for achieving success in near future. Through this therapeutic intervention, Adam can share the stimuli of the behavioural issues of anxiety and phobia as well as overcome his problems through continuous clinical intervention, counselling process and treatment, where Adam can understand the positive and negative behavioural activities as well as overcome his childhood fear over the period of time.

Conclusion

Through therapeutic intervention planning, it is possible to protect the livelihood of the individual, who are suffering from mental disorders and illness. In this resent situation, Adam is suffering from anxiety and phobia, due to the childhood experience of physically abuse by father and attacking by the neighbours. Hence, the issue of anxiety, depression as well as phobia of not communicating with the society are raisings over the period of time, and it leads to social isolation, depression, sleeping disorders. It is hereby essential for the mental health care team to support Adam for overcoming the critical phase and motivate him to engage with the social activities to stay healthily. There are different therapeutic intervention such as psychodynamic, person centred and exposure therapies, which are beneficial to support the patient with mental illness. As per the Adam's current situation, exposure therapy is considered as the best way to treat the individual and protect his self-esteem and actualization. Through identifying the stimuli by discussing the childhood experience I, it is possible for the health care providers to identify the causes of his fear and protect him through continuous communication, maintain patients safety and security, empathy and resect. The care giver develop therapeutic relationship with Adam for expecting good communication and coordination from his end, so that he can be empowered and share this perception about the anxiety and phobia. It further provides a scope to the care givers to implement exposure therapy and identify the stimuli to treat Adam and it is beneficial for Adam to overcome the issue of anxiety and phobia through continuous social activities independently, increasing self-esteem and actualization.

Reference List

Baumgardt, J., Schwarz, J., Bechdolf, A., Nikolaidis, K., Heinze, M., Hamann, J., Holzke, M., Längle, G., Richter, J., Brieger, P. and Kilian, R., 2021. Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC psychiatry, 21(1).

Beattie, D., Murphy, S., Burke, J., O’Connor, H. and Jamieson, S., 2019. Service user experiences of clinical psychology within an adult mental health service: an IPA study. Mental Health Review Journal.

Beck, A., 2019. Understanding Black and Minority Ethnic service user's experience of racism as part of the assessment, formulation and treatment of mental health problems in cognitive behaviour therapy. The Cognitive Behaviour Therapist, 12.

Chaidemenaki, L., 2021. Together and apart: using Plasticine as a sensory therapeutic intervention for a service user diagnosed with severe learning disabilities. International Journal of Art Therapy, pp.1-6.

Hartley, S., Raphael, J., Lovell, K. and Berry, K., 2020. Effective nurse–patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International journal of nursing studies, 102, p.103490.

Horgan, A., O Donovan, M., Manning, F., Doody, R., Savage, E., Dorrity, C., O’Sullivan, H., Goodwin, J., Greaney, S., Biering, P. and Bjornsson, E., 2021. ‘Meet Me Where I Am’: Mental health service users’ perspectives on the desirable qualities of a mental health nurse. International journal of mental health nursing, 30(1), pp.136-147.

Johanna, B., Julian, S., Andreas, B., Konstantinos, N., Martin, H., Johannes, H., Martin, H., Gerhard, L., Janina, R., Peter, B. and Reinhold, K., 2021. Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC psychiatry, 21(1), pp.1-13.

McPherson, S., Rost, F., Town, J. and Abbass, A., 2018. Epistemological flaws in NICE review methodology and its impact on recommendations for psychodynamic psychotherapies for complex and persistent depression. Psychoanalytic Psychotherapy, 32(2), pp.102-121.

Morant, N., Davidson, M., Wackett, J., Lamb, D., Pinfold, V., Smith, D., Johnson, S., Lloyd-Evans, B. and Osborn, D.P., 2021. Acute day units for mental health crises: a qualitative study of service user and staff views and experiences. BMC psychiatry, 21(1), pp.1-12.

O’Keeffe, D., Sheridan, A., Kelly, A., Doyle, R., Madigan, K., Lawlor, E. and Clarke, M., 2018. ‘Recovery’in the real world: Service user experiences of mental health service use and recommendations for change 20 years on from a first episode psychosis. Administration and policy in mental health and mental health services research, 45(4), pp.635-648.

Pickard, L., Rodriguez, A. and Lewis, K., 2017. Person-centred phenomenology: service user experiences of exercise. Mental Health and Social Inclusion.

Santos, J.C. and Cutcliffe, J.R. eds., 2018. European psychiatric/mental health nursing in the 21st century: a person-centred evidence-based approach. Berlin: Springer.

Trivedi, P., 2020. Service user involvement, ethics and power in therapy services. The Handbook of Professional Ethical and Research Practice for Psychologists, Counsellors, Psychotherapists and Psychiatrists, p.2.

Turner, J., Brown, J.C. and Carpenter, D.T., 2018. Telephone‐based CBT and the therapeutic relationship: The views and experiences of IAPT practitioners in a low‐intensity service. Journal of psychiatric and mental health nursing, 25(5-6), pp.285-296.


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