Question

Tony Rossi is 73 years old man living in regional NSW. His is part of a large Italian community that established itself in the area mid last century. His family are farmers and Tony as always worked in the family business, planting and harvesting crops. These days he keeps himself busy helping his cousins maintain the farm machinery. Tony never married and now he lives on his own following the death of his mother, six months ago. His cottage is fifteen kilometers out of town, located near the home of his older sister and her husband. Tony was diagnosed with schizophrenia when he was 19 years old. He has always been supported by his family, and he has not had an admission to for almost fifteen years. Over the years he has been case managed by community mental health nurses at the community health Centre. Now he sees his GP once a month for a depot injection. He has been offered his medications as oral tablets, but he has always preferred the depot injection. He fears becoming unwell, and then made an involuntary patient under the State Mental Health Act and spending time in seclusion. After his first admission to a large regional psychiatric hospital in 1968 he experienced periods of long inpatient stays until a community mental health team was set up at the new community health center in the early 1980's. For many years Tony could not talk about his experiences in the hospital where his treatment included long periods of seclusion and physical restraint, and several treatments of Electroconvulsive Therapy. However, later in his 60's he shared his story of hope and recovery from the trauma of his time in the hospital, to a local group supporting young people who were known to the juvenile justice system. Tony sees his GP every month and is currently being managed for schizophrenia, diabetes type 2, hyperlipidemia, chronic obstructive airways disease and arthritis in his left hip. He is reluctant to agree to a hip replacement because he does not want to be admitted to hospital. He does not drink but does report smoking ten cigarettes a day. Medications: paliperidone palmitate 100mg monthly; Atorvastatin 10mg bd; Metformin ER 1500mg daily, Panadol Osteo 665mg TDS. Today Tony arrives at the Community Health Centre to see Jenna, the mental health nurse. Jenna had been his case manager several years ago, before he was transferred to GP care. He had asked for an appointment because since his mother passed away six months ago, he finds he feels sad all the time, and does not want to join his cousins in the machinery shed. He is worried he will end up in hospital again. On arrival he noticed how noisy the waiting room was with people crowding around the reception desk, people yelling and phones ringing. When it came to his turn to speak, he was told that he had missed his appointment and his doctor couldn’t see him. The person at reception said they were booked out and if he couldn’t be on time, that was too bad, and he would have to wait till the next available time. But he said was sure he had the right time and he said so, using a profanity in Italian. He fumbled in his pockets for the card with the appointment date, but she crossed her arms, raised her voice, and told him to ‘go away and learn to speak English and if he didn't move away from the desk, she would call security'. Tony could feel himself starting to shake, his face feeling hotter and hotter, and clenched and unclenched his fists. He was trying so hard to keep control and he knew if he didn’t move, he might do something he'd regret and end up in seclusion again. Just then, Jenna, the practice nurse came through the door. She made eye contact and smiled and said ‘Hi Tony, I’m glad you made it. Come inside and let's have a chat.'

1. Identify incidents inTony’sl life that are known to cause trauma for people when they are admitted to an inpatient mental health unit and describe how these have impacted his life. (Please answer it according to the scenario) Also, focus on the impact of trauma and the principles of trauma-informed care

Answer 1

ANSWER -

Incident's which are known to cause trauma when admitted to an inpatient mental health unit :

• Long periods of seclusion: Long periods of isolation from other people will deteriorate their mental illness further.
• Physical restraints : By restraining people they feel humiliated and worthless followed by rage and resentment.Sadness ,despair and injustice was also reported by some people.
• Electroconvulsive therapy : It causes confusion and loss of memory which have negative impact on the mental health of the person.
• So from above all points we can say that patient will have deleterious physical and psychological consequences.
• He got afraid of hospitals and stopped seeking treatment from mental care unit which lead to further deterioration of his health.

PRINCIPLES IN TRAUMA INFORMED CARE

• Safety : Ensuring physical and emotional safety.
• Choice : Individuals are provided clear and appropriate messages about their rights and responsibilities.
• Collaberation : Individuals are provided significant role in planning and evaluating services.
• Trustworthiness : Task clarity.respectful and professional boundaries are maintained.
• Empowerment : Providing an atmosphere that allows individuals to feel validated and affirmed with each and every contact at the agency.