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Running Head: MENTAL HEALTH CASE STUDY

Belmont Pines - Mental Health Case Study

Caitlyn Hillier

Youngstown State University

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Running Head: MENTAL HEALTH CASE STUDY
Abstract

Mental illness awareness and education has increased greatly in order to help decrease

the stigma and get patients the help they need and deserve. This case study was conducted

through observation, assessment, interview, health history, and clinical data on a mental health

patient with major depressive disorder. Patient ZC is a twelve-year-old female who has been

admitted to Belmont Pines on multiple occasions in the last three years, this time because of an

altercation with her mother. The patient has many other diagnoses, such as bipolar disorder,

anxiety, and attention deficit hyperactivity disorder. The patient is on self-harm precautions and

was admitted by her mother. In her interview she communicated that “this place is horrible, and I

want to go home, it doesn’t help me, and I don’t like to use coping skills because they don’t

work.” I was with the patient from around three o’clock to around nine o’clock, and I was able to

interview her for almost twenty minutes around five. She was not very interested in the interview

and kept getting off track asking me personal questions to which I had to redirect.
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Running Head: MENTAL HEALTH CASE STUDY

Objective Data

Patient ZC was admitted to Belmont Pines Hospital on September 30, because of major

depressive disorder and superficial cutting to the skin, along with spraying aerosol bleach into

her mouth. I was caring for this patient on October 1, 2019. Her psychiatric diagnoses are major

depressive disorder, bipolar disorder, anxiety and ADHD. The patient is on self-harm

precautions due to being admitted with twenty superficial cuts on her left forearm and ten

superficial cuts on her left arm. ZC has a history of being assaultive with her mother, and doing

things such as pulling hair, kicking, throwing things at her, and pulling a knife on her. The

patient did not have any labs on file due to being admitted the day prior, but stated she was not

on any medication at home. On the day of care, her behavior seemed a little on edge, she made it

clear she did not want to be at Belmont Pines and that this is all her mothers’ fault. Treatments

that the patient endured were group therapy to help develop coping skills, seeing Dr. Farris

(psychiatrist) individually, and taking Latuda for her mood. Safety measures provided for this

patient were fifteen-minute checks to ensure the patient was safe, pulling all belongings that can

be used to potentially harm herself such as shoelaces. The patients chart stated that she had

feelings of hopelessness, feeling that she was a burden to others, high anxiety and stress, and

emotional pain. All of these things combined were the reason for her admission to Belmont

Pines.

Diagnoses

Major depressive disorder is defined as “depressed mood or loss of interest or pleasure in

usual activities. Evidence will show impaired social and occupational functioning that has
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Running Head: MENTAL HEALTH CASE STUDY
existed for at least two weeks.” [ CITATION Tow17 \l 1033 ]. Signs and symptoms of major

depressive disorder are feelings of sadness, tearfulness, emptiness or hopelessness, angry

outbursts, irritability or frustration, loss of interest or pleasure in most or all normal activities,

sleep disturbances, tiredness and lack of energy, reduced appetite and weight loss or increased

cravings for food and weight gain, anxiety, agitation or restlessness, slowed thinking, speaking

or body movements, feelings of worthlessness or guilt, fixating on past failures or self-blame,

trouble thinking, concentrating, making decisions and remembering things, frequent or recurrent

thoughts of death, suicidal thoughts, suicide attempts or suicide, unexplained physical problems,

such as back pain or headaches. [ CITATION Tow17 \l 1033 ]. Bipolar disorder is defined as

“mood swings from profound depression to extreme euphoria (mania) with intervening periods

of normalcy.” [ CITATION Tow17 \l 1033 ]. One key sign of bipolar disorder is extreme mood

swings from one extreme to the other. Anxiety is defined as “a feeling of discomfort,

apprehension, or dread related to anticipation of danger, the source of which is often nonspecific

or unknown.” Anxiety is considered a disorder when fears and anxieties are excessive and there

are associated behavioral disturbances such as interference with social and occupational

functioning. [ CITATION Tow17 \l 1033 ]. ADHD is defined as “constant, spontaneous,

uncontrollable, overt, purposeless behavior unconsciously displayed by children.”[ CITATION

Cal1 \l 1033 ]

Stressors

Prior to admission, ZC had gotten into a physical altercation with her mother that had

progressed from an argument. ZC has a history of being abusive toward her mother and has

physically harmed her in ways such as kicking, hitting, and pulling hair. This altercation,

although unclear of what caused it, lead to the patient spraying aerosol bleach into her mouth as
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Running Head: MENTAL HEALTH CASE STUDY
well as cutting herself thirty times. Patients history with mom has always been physical, and

patient states “my mom just pisses me off and I just freak out and can’t control myself.” The

patient has difficulty acknowledging her problems as well as blaming others for them. The

patient stated that when she is stressed, she doesn’t like to use coping skills but if she has to, she

prefers to use deep breaths and counting to ten. She says that these things don’t generally help

her, but she knows what coping skills are and why you are supposed to use them.

History

Patient ZC has a family history of mental illness. Both of her parents have attempted

suicide. Her mother is diagnosed with major depressive disorder, body dysmorphic disorder,

panic attacks, and bipolar disorder. Her father was diagnosed with bipolar disorder, obsessive-

compulsive disorder and body dysmorphic disorder. ZC also witnessed domestic violence, has a

history of significant and traumatic loss from losing her father in July 2019. The patient stated

upon her admission assessment that she does not feel safe at home due to abuse being reported

and previous children services involvement. The patient’s family having a history of mental

illness made ZC more susceptible to having one herself, as well as coming from an unhealthy

environment with parents who engaged in physical altercations in front of the children. Children

from homes with maladaptive coping strategies are more likely to develop behavioral or mental

health problems than children who come from a nurturing environment with structure and rules.

Nursing Care

Nursing care that I provided was very little, I was able to interview the patient for twenty

minutes and help her get new socks and toiletries for a shower, but other than that most of her

nursing care is done in the morning when vitals are taken. Some milieu activities that she had
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Running Head: MENTAL HEALTH CASE STUDY
throughout the day included fifteen-minute checks to ensure safety. The patient was put on

suicide precautions for her stay due to her admission reasoning being that she tried to kill herself.

The patient was not allowed to have any items that could potentially cause harm to herself like

shoelaces or anything sharp. The patient was told to notify the staff of any thoughts of self-harm

when they occurred and what she wanted to do. ZC was also instructed to notify the staff of any

potential triggers she may have. One of her triggers was the constant screaming by the other

patients. She said that it scared her and reminded her of being at home when her parents and her

would fight, and that because of the screaming she was unable to sleep. Throughout her stay, ZC

would also be going to many group therapy sessions to help her learn how to handle all of the

things she was feeling inside. In group, she is given the opportunity to share her feelings about

the specific subjects and what she does pertaining to those subjects. She also has to opportunity

to learn from her peers about new coping skills. Group therapy is beneficial because it supports

making friends and knowing that you are not alone. The groups stay relatively on task and

benefit all of the children even though they may not realize. ZC also sees Dr. Farris, who is a

psychiatrist. She meets with him daily to discuss her feelings for the day, her medications and

any problems she may be having. Dr. Farris goes into these sessions with a positive attitude

hoping to shed some of that energy onto his patients.

Spiritual

Although in her chart it says that her religious affiliation was Christian, she said that she

did not practice very often and very seldom went to church. Statistically, if you have any form of

religious affiliation you are less likely to commit suicide than those who are not religious due to

thinking it is a sin to whomever your higher power is. [ CITATION Tow17 \l 1033 ]. ZC states

that “neither me or my mom go to church but we are Christian because that is what we are
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Running Head: MENTAL HEALTH CASE STUDY
supposed to be but I’m not sure I believe that in stuff like that.” I asked the patient how she felt

about praying and asking for forgiveness and she said that she does not pray or practice religion

heavily.

Evaluate Outcomes

During her admission, the patient’s long-term outcomes related to care was to improve

mood, behavior and thinking before discharge. A long-term concern for the treatment team

related to care was the bad relationship between ZC and her mother, and ways that she can

control her impulsivity. Another outcome that the patient had was to no longer feel the need to

harm herself, and to give her good coping skills when she does feel the need. Coping skills were

a big part of her treatment on her day of care and being able to use those properly is a big goal

for discharge. The patient is not currently on medications at home but that was subject to change

based on how her treatment went throughout the week.

Discharge Plans

The plan for discharge was not fully established yet due to being a new admission to the

unit, however some plans for discharge included using nonpharmacological methods to cope

with depression, anxiety, and self-harm tendencies. The patient was instructed in group with

many ways to cope with her emotions of hopelessness and how to deal with those and should

continue to use them post discharge. Another plan for discharge was to no longer self-harm and

to use that energy and put it into something constructive such as drawing or writing. The patient

would also benefit from therapy outside of group to help her talk through some of her recent

trauma such as her father passing unexpectedly.

Nursing Diagnoses
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Running Head: MENTAL HEALTH CASE STUDY
The treatment team had implemented short term goals for the patient during her stay.

Some of those were:

1. Patient describes own anxiety and coping patterns.

2. Patient will seek help when experiencing self-destructive impulses.

3. Patient will demonstrate alternative ways of dealing with negative feelings and

emotional stress.

I was unable to assess if the patient is actively achieving the goals set by the team due to

care being so short and not being a continuous caregiver.

Some possible nursing diagnoses for this patient are:

1. Risk for self-directed violence as evidenced by suicidal behaviors (attempts,

ideations, plan, available means). [ CITATION Tow17 \l 1033 ]

2. Risk for violence, other directed, as evidenced by impulse control and family history

of violence. [ CITATION Bal19 \l 1033 ]

3. Anxiety related to situational and maturational crises as evidenced bu decreased

attention span, poor impulse control, feelings of discomfort, apprehension or

helplessness, and restlessness. [ CITATION Bal19 \l 1033 ]

4. Ineffective coping related to situational crises as evidenced by inadequate problem

solving and ritualistic behavior or obsessive thoughts. [ CITATION Tow17 \l 1033 ]

5. Risk for parental role conflict related to children with attention deficit hyperactivity

disorder. [ CITATION Cal1 \l 1033 ]

Conclusion
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Running Head: MENTAL HEALTH CASE STUDY
Overall, ZC was a pleasant young girl with multiple personality disorders and mental

health issues. A lot of her problems stem from inheriting the same mental health issues that her

parents had, as well as not knowing how to adequately manage these illnesses. Due to recent

traumatic loss amongst other things, this patient is more susceptible to having an exacerbation of

her illnesses than someone who has not had a traumatic loss. My day of care with ZC consisted

of a brief interview, reading charts, and observing a small portion of group therapy. It is very

important for the patient to navigate and express her emotions, as well as her thoughts of self-

harming or suicide because she will be more likely to succeed and not be readmitted with the

proper therapies and coping skills implemented. The patient must be able to identify when she is

feeling hopeless or depressed and be able to adequately seek help for it. I feel that this patient

will be unlikely to be readmitted if all of these things are followed through. A mutual

understanding between her and her mother and boundaries and limits being set on behaviors

should help maintain outbursts and physical altercations with mom, and the use of medications

as needed will help to stabilize the patient and her emotions. I feel that ZC has a lot of potential

and she will not be able to reach her potential without a support team behind her.

Reference:
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Running Head: MENTAL HEALTH CASE STUDY
Ball, J., Bindler, R. M. G., Cowen, K. J., & Shaw, M. R. (2019). Child health nursing: partnering

with children & families (3rd ed.). New York, NY: Pearson.

Calhoun, G., Greenwell-Iorillo, E., & Chung, S. (n.d.). Attention-Deficit Hyperactivity Disorder:

Mountain or Mole Hill?, 244–251.

Townsend, M. C., & Morgan, K. I. (2017). Essentials of psychiatric mental health nursing: concepts

of care in evidence-based practice (7th ed.). Philadelphia, PA: F.A. Davis Company.