Understanding Complexity in Practice

Introduction1

In the recent past complex patient concept has been used by different healthcare professionals due to the increased number of patients being admitted in different healthcare facilities with complex and underlying health needs (Abell et al., 2010). They have been necessitated to adopt this approach to ensure this kind of patients are receive relevant and specific care that can help them heal and go back to their normal conditions (Townsend & O’Brien, 2015). In this paper we are going to consider the case study of Charlotte (Appendix A) who has personal disorder. The team is trying to use a collaborative high-quality approach to stabilize the patient’s reaction to people and be discharged (Townsend & O’Brien, 2015). The approach will be combined with social, physical, and environmental factors that may be affecting the psychological state of Charlotte. A mental health nurse together with a Psychist will be involved with other professionals from other fields to consider the complexity of the patient conditions through assessment, clinical reasoning, choosing interventions, and decision-making (Townsend & O’Brien, 2015). In addition, an action plan has been developed to indicate my personal and professional development in the period that I have been a social worker student. There are two reflective accounts that the personal and professional journey is based on in Appendices B & C to enable me continue with my professional development journey.

Addressing complexity:

By employing the complexity theory in this case analysis, permits awareness of various experiences of a person from molecular levels to cultural levels (Murphy & McVey, 2010). These experiences are non-linear and multi-determined to explain the procedure of transition. The complexity theory will use a biopsychosocial model that Engel suggested in 1977 as theoretical support to upgrade the explanation of Charlotte's specific circumstances (Murphy & McVey, 2010). The model indicates that every person is distinctive, and they can be uniquely affected by complex systems of psychological, social, and biological factors (Murphy & McVey, 2010). Compared to the old ways of controlling the medical model, which sees pathology or illness will interact with medical treatment in a similar manner (Murphy & McVey, 2010). Subsequently, social and psychological influences in today's world find it hard to fit in this limited medical structure, leading to the development of a holistic biopsychosocial model smoothly (Murphy & McVey, 2010). The framework of Human Occupation (MOHO) is equally important when we use it to synthesize with the BPS to guarantee every factor of Charlotte's life is acknowledged (Murphy & McVey, 2010). It will help regain and redesign roles as the quality of life (QOL) is addressed.

Regarding Charlotte, effective communication needs to assess performance, volition, habituation, and capacity (Tyrer, Reed & Crawford, 2015). They target to develop and increase her occupation interaction as she might be having a decrease in volition (Tyrer, Reed & Crawford, 2015). Intrinsic elements experience with Oppositional Defiant Disorder (ODD) individuals indicate that they have uncooperative, defiant and hostile behaviour that make them have a different way of behaviour (Tyrer, Reed & Crawford, 2015). Agitation and hallucinations might be dangerous when mental health affects social engagement and behavioral disturbances related to Charlotte's case study of harming herself, failing to have proper relationships, and abusing alcohol (Tyrer, Reed & Crawford, 2015). Hence, Charlotte might be experiencing psychiatric symptoms that might result from changes in medication. She might also need a risk and double handling assessment conducted by a doctor (Tyrer, Reed & Crawford, 2015).

Extrinsic elements are also essential, and they include Charlotte having restricted domestic dependence and self-care because of being in a nursing home (Townsend, 2014). Past studies have expressed that the consequences of daytime drowsiness and chronic stress in Oppositional Defiant Disorder patients have built a burden on caregivers and patients' health results (Townsend, 2014). The study mentions Charlotte to be buying burned products, which can be due to signs Physical Abuse related to ODD (Townsend, 2014). She may be affected on how she keeps relationships, seeing herself as a failure and harming herself and start abusing alcohol.

A specific complication mentioned in this case analysis is that awareness issues can lead to more challenges for mental health (Vélez-Moreno et al., 2017). While Charlotte may not know the aim of interventions and her complex impairments, misunderstandings arise when assisting (Vélez-Moreno et al., 2017). Therefore, a simple discussion among the multidisciplinary team (MDT) is vital for analyzing risks versus benefits (Vélez-Moreno et al., 2017). For example, medical awareness, symptom management, and care provision, one symptom can be Post Traumatic Stress Disorder (PSTD) (Vélez-Moreno et al., 2017). Hence, in 2015, the World Health Organization emphasized the importance of working collaboratively with 'Global strategy on people-centered and integrated health services, indicating positive relationships made within disciplines to shy off failures in communication demonstrated in previous vitals events the Francis report (Vélez-Moreno et al., 2017). Nevertheless, when putting the hospital setting into consideration, we realize an increase of the population with various long-term health issues, increasing collaborative working demand (Vélez-Moreno et al., 2017). Often, this has proven to be challenging, as the hospital does not meet the cohesive team demand, resulting in insufficient resources and staff, and these challenges the policies' suggestions of interprofessional working (Vélez-Moreno et al., 2017).

Clinical reasoning in the assessment process:

Given ODD's advanced stage showcased in Charlotte, systematic approaches embraced are biomechanical and educative approaches (Fenton et al., 2013). Caregivers and families will use these two approaches to get advice on transfer and beneficial graded occupation that rim with Charlotte's mental strength and capability (Fenton et al., 2013). Other applicable approaches in Charlotte's case include the compensatory and cognitive approaches (Fenton et al., 2013). They focus on enabling cognitive stimulation by maintaining an active mental state through systematic development, social interaction, and practical strategies to aid in her disorder (Fenton et al., 2013).

Regarding the case analysis, the multidisciplinary team will collaborate to assess Charlotte's referral detail and give specific examinations to team members, confirming the explanation of the clarification role explained to avoid repetition and duplication (Levola et al, 2014). MDT will use conditional and procedural clinical reasoning to give information on conducted interventions and assessments when making decisions (Levola et al, 2014). The clinical ideas will assist in achieving an initial measure of Charlotte's immediate condition (Levola et al, 2014). The hospital will accomplish this by embracing a descriptive approach to know how to utilize function when considering life trajectory in the long term (Levola et al, 2014).

It is vital to note that Charlotte was diagnosed with an incompetent mental issue at the information-gathering stage (Langas, Malt & Opjordsmoen, 2012). Therefore, doctors will use Addenbrooke's Cognitive Examination-III (ACE-III), suggested by the health department, as a cognitive screening tool (Langas, Malt & Opjordsmoen, 2012). The Mental Health Nurse and the social worker will conduct the assessment to examine whether there have been signs of further cognitive decline (Langas, Malt & Opjordsmoen, 2012). The standardized tool embraces the bottom-up model and dwelling on cognition with a minor influence. Previous studies confirm that the micro impact meets satisfactory standards of reliability and validity for examining personal disorder patients sensitively (Hasin et al., 2011). In addition, an approved method is critical at this stage because the cognitive level of impairment found will assist in understanding intervention efficiency.

More key factors to check are Charlotte's condition, age, and the risk of alcohol, which adds more concern to the social worker and the mental health nurse. The two (mental health nurse and social worker) will examine the depth of her frailty (Kessler et al., 2012). The mental health nurse and the social worker will conduct standard random tests, which include five-times-sit-to-stand, highlighting strong test-reliability and intra-reliability and is an approved measure in observing relationship keeping ability (Kessler et al., 2012). The mental health nurse and the social worker can also do a timed up-and-go test to foretell the risk of alcohol because it has proved to be a more reliable and valid test (Kessler et al., 2012). These macro examinations are a functional analysis that is important in measuring ODD 's extent on Charlotte's mental state conducted through observation and objectively writing the needed care and assistance.

Goal planning practice that is client-centered

The latest clinical recommendations like The Patient and Public Involvement Policy put the patient at the primary point in the process of goal setting (Lai et al., 2015). It helps generate congruent goals in attaining the full potential of a patient as an occupational human (Lai et al., 2015). The suggestions complement embracing narrative and interactive reasoning at this point to enable patients to proffer their motivations (Lai et al., 2015). It does this by the patients selecting particular goals that meet their occupational needs and capabilities (Lai et al., 2015). The transfer power benefits can help in motivating participatory democracy, service user accountability, and transparency with the growth of commitment and understanding (Lai et al., 2015).

According to Charlotte, she is a vulnerable adult with protection worries because ODD puts restrictions on decision-making on herself and disturbs her capability to air her emotions or needs (Jahng et al., 2011). Hence, the Mental Capacity Act 2005 recommends that for people with such a condition, available care should need approval through the best interests meeting of the family, MDT, and the caregivers to protect these patients (Jahng et al., 2011). They can also apply the Deprivation of Liberty Safeguards together with the policy to enable a holistic model. Furthermore, in complex cases like this one of Charlotte, there is a need to involve a social worker under the Care Act 2014 to decide on the services appropriate to cater to the patient's needs (Lai et al., 2015). Researchers argue that applying professional services should increase in such a situation to give patients room to be part at a specific level in line with their cognitive capability.

Consequently, the mental health nurse must address the use of the therapy when consciously working with the patient to create rapport and trust with the patient (Jahng et al., 2011). By so doing, the patient will maximumly get involved in the entire process and the required feedback while making it easier for the mental health nurse to give maximum results (Jahng et al., 2011). Therefore, the help in graded circumstances will help design important goals by negotiating and co-producing autonomy and maintaining the patient-centered state. The model of developing SMART plans with Charlotte contains discussion dwelling on specific memories of past roles and interests (Ball et al., 2006). Following this result, the mental health nurse will know the vital areas to use in improving QOL and growing the locus of control.

Short-term goals:

Establishing a short-term intervention for Charlotte

Finding effective methods of supporting and improving Charlotte’s by connecting her to a psychiatric and health professional who can her help her have a stable mental status (Ball et al., 2006).

Intermediate-term goals:

Helping Charlotte gain her normal mental status and enabling her go back home to meet her children and family (Ball et al., 2006).

Interventions:

Professional standards that skills of social workers and psychiatric will be used in analysing and guiding to understand what the condition of Charlotte requires, the likely challenges to face during the treatment process (Westermeyer & Thuras, 2005). The findings are going to be applied to ensure Charlotte stabilizes and successfully goes back to her normal status.

Because the main interest of Charlotte was to go for shopping buy gifts for her children, there will be need for her to be given a chance to meet them frequently as a short-term measure while exploring a significant occupational intervention that will ensure she gets back to her normal status (Westermeyer & Thuras, 2005). Frequent visiting of her children will play an important role in her recovery journey. It will enable her forget the past memories that make her lose control and feel abused (Contrada & Baum, 2010). It will enable her develop new memorable memories that would her overcome her current challenges (Contrada & Baum, 2010). If Charlotte meets her children frequently, she is likely to have a loving heart and stop purchasing banned items so to be with the children forever. She will start discussing her journey to recovery with the mental health nurse which will enable him to understand the kind of feeling and the current healing progress (Contrada & Baum, 2010). The discussion will enable the mental health nurse advise her on how she could overcome her problems and quickly recover and go home to join the rest of her family (Contrada & Baum, 2010). Studies have indicated that patients with similar problem to Charlotte have improved their behaviour by having constant communication with the mental health nurse (Contrada & Baum, 2010). Through thus she will effectively establish personal meaning that come as a result of the activity, consequently increasing the QOL. It will make her gain the sense well-being and accomplishment of her mental health (Ball et al., 2006). It will also help her cope psychologically through the influence of the intervention where a routine will be developed to be promoted and integrated as a form of motivation for effective relations improvements and other ADLS (Ball et al., 2006).

For the intervention to be complete, an analysis will be required identified to establish where Charlotte fails to reason and undertake her normal activities without falling into purchasing of banned product like alcohol and harming herself (Abell et al., 2008). Therefore, it would important to ensure that Charlotte, is put in a place where she cannot meet the banned products and alcohol easily (Abell et al., 2008). It will be important that those who identify the environment seek a place where it is interesting to her and she can be with people who do not take alcohol and other banned products (Abell et al., 2008).

With the information obtained, Charlotte will be taken to different people who she will take care of and ensure that she forgets accessing alcohol (Alum et al., 2008). Further, it would be important to ensure that she gets people who understand and will always remind her of the importance of keeping positive relationships and avoiding alcohol (Alum et al., 2008). Her children will be required to visit her and spend long periods with her and she will be assisted with gifts that she can give them so as to fulfil her ambition of being a good mother to them. She will have to demonstrate, that she is able to be with people close to her, not harm herself in anyway, and not to be interested with banned products and alcohol (Alum et al., 2008). She will have to cooperate in addressing the current challenges she is facing like purchasing banned products and harming herself.

The intervention that Charlotte needs requires unique skills and expertise of the mental health nurse, psychiatrist and a social worker who will closely work together in helping her achieve better mental health status (Fureman et al.,1990). A descriptive and interactive reasoning approach will be required throughout the process where the social worker, mental health nurse, and Psychiatrics will be allowed to share with Charlotte in order to understand the challenges and recommend the kind of help that could improve her condition (Fureman et al.,1990; Zimmerman, Rothschild & Chelminski, 2005). A macro approach intervention will be adopted where the information obtained will be applied in shaping further decisions.

Outcome measures:

When Charlotte improves and ready to be discharged, there she will have a meeting with all the three professionals who closely dealt with her problem and the social worker will be given the mandate of ensuring that she does not get back to her previous state (Naylor et al., 2012). The social worker will be required to closely monitor her by visiting her twice a week and seeking feedback from her family members. The mental health nurse and psychiatrics will be required to give recommendations based on the progress the she will be making to allow safe occupations (Joachim, Sturmberg & Martin). The main role of the social worker is to give Charlotte close attention for sufficient communication and ensure the healing process reaches the correct levels (Naylor et al., 2012). After a month of close observation, the social worker can reach the hospital team to inquire if the level of graded activities is on a good progress and introduce a new approach of undertaking different occupational approach (Naylor et al., 2012). It will enable the mental health nurse and psychiatrics to respond to the progress and the intervention outcome.

Conclusion:

The above discussion indicates how patients with mental health problems can be helped through having a user involvement service and client-based approaches to manage complex patients. It ensures there is constant improvement with the patient being part of the improvement process. Collaboration by professionals from different disciplines/fields will assist in ensuring Charlotte has the best care and attention to ensure her complex situation addressed by having all occupational health needs. Evidence-based approach that was supported by the different professionals to ensure any gap that could arise is addressed to ensure Charlotte’s life is improved.

Action plan:

There is need for professional to engage a reflective approach when they are dealing with cases associated with social and health field (Galea, 2012). They should ensure their performances are well reflected it forms the best tool for transformation and examining there their practice (Magallón-Neri et al., 2014). Through reflection, professionals in the healthcare sector are able to critically evaluate and become self-aware of themselves and relate them with the current demands of the industry (Samuels, 2011). Through this, they are able to understand personal competence that enable them to develop themselves as persons and professionals. By participating in the multi-disciplinary approach and module, I have found serious areas of opportunities to consider in my career and gained deep insights on how to increase the level of my competence and develop my professional identity as a social worker student. Further, I have come to understand the role of different professionals in the medical field and how they are related to each other (Westermeyer & Thuras, 2005). I have known on how to collaborated with a team of health professions to ensure the patient experience and quality of care is improved. There are new skills used in the healthcare sector like assessment, clinical reasoning, decision making and choosing of interventions, that I have learned on how they can apply in practice (Yen et al., 2003).

Due to the experience that I have had, I have selected two areas which are mental assessment that come initially before engaging the patients and collaborative working with other healthcare professionals from other fields in the formative presentation as my two areas of reflection (Appendix B & C). The two reflections will be based on the Gibbs reflective cycle. This has been clearly indicated in the effective theoretical framework associated with the interprofessional patient-centred healthcare. Undertaking the reflection process into completion has helped me develop an action plan as indicated in the table below which helps in development of a plan on how I could improve my area of weakness. Further, it indicates how I could get deep understanding of the existing knowledge in the industry and improve my Continued Professional Development (CPD) cycle.

Dig deeper into Understanding Causes and Risk Factors of Escherichia with our selection of articles.

References

Abell F, Potter C, Purcell S, Broomfield H, Griffin M, Restrick L, Erskine A, Stern M (2008). The Effect of Inclusion of a Clinical Psychologist in Pulmonary Rehabilitation (PR) on Completion Rates and Hospital Resource Utilisation (Hospital Admissions and Bed Days) in Chronic Obstructive Pulmonary Disease (COPD). Abstract presented at 2008 Winter Meeting of the British Thoracic Society. British Thoracic Society website.

Alum R, Sturt J, Lall R, Winkley K (2008) ‘An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status’. Patient Education and Counselling, vol 75, no 1, pp 25–36.

Ball, S., Carroll, K., Canning-Ball, M., & Rounsaville, B. J. (2006). Reasons for dropout drug abuse treatment: symptoms, personality and motivation. Addictive Behaviors, 31, 320–330.

Chris Naylor, Michael Parsonage, David McDaid, Martin Knapp, Matt Fossey, Amy Galea, (2012). Long-term conditions and mental health. The cost of co-morbidities. Center of Mental Health.

Clifton, Andrew Hemingway, Steve Felton, Anne Stacey, Gemma. Fundamentals of mental health nursing: an essential guide for nursing and healthcare students.

Combaluzier, S., Gouvernet, B., & Bernoussi, A. (2009). Impact of personality disorders in a sample of 212 homeless drug users. Encephale, 35(5), 448–453.

Contrada RJ, Baum A (2010). The Handbook of Stress Science: Biology, psychology and health. New York: Springer.

Fenton, M. C., Keyes, K., Geler, T., Greenstein, E., Skodol, A., Krueger, B., Grant, B., & Hasin, D. (2012). Psychiatric comorbidity and the persistence of drug use disorders in the United States. Addiction, 107, 599–609.

Fureman, B., Parikh, G., Braga, A., & McLellan, A. T. (1990). Addiction Severity Index: A guide to training and supervising ASI interviews based on the past ten years (Fifth edition). Pennsylvania: The University of Pennsylvania/Veterans Administration, Center for Studios of Addiction.

Hasin, D., Fenton, M. C., Skodol, A., Krueger, R., Keyes, K., Geier, T., Greenstein, E., Blanco, C., & Grant, B. (2011). Personality disorders and the 3-year course of alcohol, drug and nicotine use disorders. Archive of General Psychiatry, 68, 1158–1167.

Jahng, S., Trull, T., Wood, P., Tragesser, S. L., Tomko, R., Grant, J., Bucholz, K., & Sher, K. (2011). Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity. Journal of Abnormal Psychology, 120(3), 656–669.

Joachim P. Sturmberg and Carmel Martin. Handbook of Systems and Complexity in Health.

Kessler, P., Terra, M., Faller, S., Stolf, R., Peuker, C., Benzano, D., & Brazilian ASI Group (2012). Crack users show high rates of antisocial personality disorder, engagement in illegal activities and other psychosocial problems. American Journal on Addictions, 21(4), 370–380.

Lai, H. M., Cleary, M., Sitharthan, T., & Hunt, G. E. (2015). Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: a systematic review and meta-analysis. Drug and Alcohol Dependence.

Langas, A., Malt, U. F., & Opjordsmoen, S. (2012). In-depth study of personality disorders in first-admission patients with substance use disorders. BMC Psychiatry, 12,180.

Levola, J., Aalto, M., Holopainen, A., Cieza, A., & Pitäken, T. (2014). Health-related quality of life in alcohol dependence: a systematic literature review with a specific focus on the role of depression and other psychopathology. Nordic Journal of Psychiatry, 68, 369–3843.

Magallón-Neri, E. M., Forns, M., Canalda, G., de la Fuente, E., García, R., González, E., Lara, A., & CastroFornieles, J. (2013). Usefulness of the international personality disorder examination screening questionnaire for borderline and impulsive personality pathology in adolescent. Comprehensive Psychiatry, 54, 301–308.

Murphy, N., & McVey, D. (2010). Treating personality disorder creating robust services for people with complex mental health needs. Routledge.

Samuels, J. (2011). Personality disorders: epidemiology and public health issues. International Review of Psychiatry, 23, 223–233.

Standing, Mooi. Clinical judgement and decision-making: in nursing and interprofessional healthcare.

Townsend, M. (2014). Psychiatric nursing: assessment, care plans, and medications (9th ed.). F. A. Davis Company.

Townsend, M., & O’Brien, C. (2015). Psychiatric nursing : assessment, care plans, and medications (Ninth edition.). F. A. Davis Company.

Tyrer, P., Reed, G., & Crawford, M. (2015). Classification, assessment, prevalence, and effect of personality disorder. The Lancet (British Edition), 385(9969), 717–726. https://doi.org/10.1016/S0140-6736(14)61995-4

Vélez-Moreno, Rojas, Rivera, Fernández-Calderón, Torrico-Linares, Ramírez-López, González-Saiz & Lozano (2017). The Impact of Personality Disorders and Severity of Dependence in Psychosocial Problems. Int J Ment Health Addiction (2017) 15:1008–1022/p>

Vergara-Moragues, E., González-Saiz, F., Lozano, O. M., & Verdejo-Garcia, A. (2013). Psychiatric profile of three-month retention in cocaine-dependent patients treated in a therapeutic community. Journal of Studies on Alcohol and Drugs, 74, 452–459.

Westermeyer, J., & Thuras, P. (2005). Association of antisocial personality disorder and substance disorder morbidity in a clinical sample. American Journal of Drug and Alcohol Abuse, 1, 93–110.

Yen, S., Shea, M. T., Pagano, M., Sanislow, C. A., Grillo, C. M., McGlashan, T. H., Skodol, A. E., Bender, D. S., Zanarini, M. C., Gunderson, J. G., & Morey, L. C. (2003). Axis I and II disorders as predictors of prospective suicide attempts: findings from the Collaborative Longitudinal Personality Disorders Study. Journal of Abnormal Psychology, 113, 375–381.

Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DMS-IV personality disorders in psychiatric outpatients. American Journal of Psychiatry, 162, 911–1918.

Case Study

relationships with those around her. She witnessed frequent physical violence within the home and was abused by a family friend who used to visit the house regularly to get drunk with her dad. Dad left the home when Charlotte was 12 and Charlotte’s mum was able to provide her with a loving environment for the most part although struggled to cope and Charlotte was often sent to live with relatives for short periods.

Charlotte had two children (Ben and Sarah), the children have been permanently adopted and Charlotte has annual letter box contact. She misses them and it is a great source of distress that she ‘let them down’.

Charlotte enjoys looking after other people and has adopted a motherly role on the ward, unfortunately this has caused some problems as she has procured banned items for her friends in the belief that she is helping them. She is generally polite to staff on the ward, she is very eloquent and has clear ideas about what does and doesn't help her - she feels that she needs to be in hospital but is not convinced that the treatment approach of DBT is particularly helpful.

Charlotte wants to have leave so that she can go to the shops to buy some christmas presents for her children, she has been told by the MDT that she can only go if she does some OT with you first.

Reflective Account 1: Collaborative working with other health care professionals

Throughout my complex module I have worked together with other healthcare professionals in addressing the complexities that come with the case study. We have had discussion on how the patient’s quality of life and situation could be improved. Planning on how we could approach the case study was key for us as it enables us to get a grasp of what we are getting into and how best we could ensure best results are delivered within the shortest time possible. At this stage we identified and made decisions about the assessment and intervention processes. Though there were challenges at the beginning of the process regarding initial assessment, the professionals who could be involved and how to avoid duplication everything took place as required.

I was assigned to help with the planning process though I had mixed feeling about my knowledge, I was supported by how the other professional were will to help and explain what is required in the process. The support helped me acquire knowledge that was important in becoming more understanding and collaborative with other professionals. It also helped me understand how to initiate a process in the

healthcare environment. After finishing the planning stage, I was given another task of undertaking the assessment of the patients. As a social work student, I was supposed to identify the problems that the patient was facing associated with my field of study. Though I was not confident, the professionals helped me gain the level confidence required to engage patients and realize the kind of information required to be obtained from them. It was an important undertaking that I cannot forget. It made me discover that continuous engagement and interaction with other professionals helps improve skills and develop enough confidence to ensure success in the industry.

There were some areas I struggled like explaining myself on different aspects. Also, my time management skills were wanting. It was an area that other professionals kept on reminding me. I could take more time in performing one specific task that otherwise I could have performed more. Another important area that I realized I was weak is when assessing the patient, I could become emotional and lose my attention on the primary activity. However, by the end of the cases study I realized the importance of collaboration and how interprofessional improves the performance of an individual in the health care set up. There are many aspects that I learnt that I could include in my CPD for improvement

Reflective Account 2: mental health initial assessments

My knowledge about mental assessments has mainly been gained through my place and classwork. At the beginning it was a difficult undertaking as I did not understand how it could be applied by standardization and functional assessment. However, after engaging in practice and trying to perform some assessment by my own I have to appreciate the importance of this procedure and how it can be applied together or individually as an approach. I have been able to learn other forms of assessment that are important in the healthcare field that can help under different circumstances. Through this process I have been able to realize how several other important tools can help in improving the patients’ quality of live and condition. In the mental disorders and addiction, I can now measure that outcome and the levels of grades that the patients have progressed and enable me change the next cause of action.

However, there was negative experiences when undertaking this process as I did not get to apply it to specific patients together with other professionals to know the areas of weaknesses. However, the support from the tutors has been overwhelming and ensured that all aspects are addressed and well understood. I have reviewed about the competency of mental assessment and determined that it’s one of the methods that meets highest standards in the industry. Through continuous learning I have been able to understand how to begin a clinical set up and learned how evidence-based approach can be combined to ensure the required standards are met.

Despite the progress I feel there is need for me to engage further practice to gain deep understanding of mental assessment. Also, I need to learn how the combination of mental assessment with other assessment tools to understand the kind of improvement that is likely to happen. I also need to deal with the issue of client-based approach and understand the aspects that need to be included. Through this reflection I have been able to learn areas that I have improve to ensure the Continuous Professional Development (CPD) moves in the right direction.