Introduction
The following essay is based on the case study of Josh, the son of Alice. Josh is 17 years old, school drop-out and suffers from substance abuse. He injects intravenous drugs for intoxication. His mother is anticipating that Josh is suffering from schizophrenia as the symptoms are likely to be similar to her brother who also had schizophrenia. Josh has anger issues as he punches hols inside the walls also yells and steals. The following essay aims to conduct a mental health assessment with proper assessment tool in order to ascertain the mental health complications through which Josh is passing. This will be followed by the analysis of the psychological consequences of mental health over Josh and his family members. The essay will also highlight the theoretical, legal, ethical and policy related frameworks in order to justify or refute the arguments behind why Josh must be deprived of freedom. At the end, the paper will highlight the recovery principle for Josh based on the recovery model framework. The essay will also focus on the recovery framework under community-based approach to help Josh overcome from his habit of substance abuse and mental health complications.
Mental health assessment
A mental health assessment is designed to diagnose mental health conditions like depression, anxiety, schizophrenia, postnatal depression, eating disorders and other psychotic illness. The mental health assessment also helps to discriminate between the mental and physical problems (Victoria State Government, 2020). In case of Josh, mental health assessment is important as he suffers from substance abuse. He smokes marijuana ad consumes alcohol. His mother Alice has found used needles in Josh’s bedroom. Alice has also complained that Josh looses temper frequently, mingles with bad crown while punches holes inside the walls to manage his anger. He has also developed tendency of stealing and yelling. Thus it would be the duty of the Glenauries Child Youth Mental Service (CYMNHA) to conduct a detailed mental assessment over Josh in order to understand his actual mental alignment. Proper identification of the mental illness will help in drafting person-centred care plan thus, improving the overall outcome of care. Alice thinks Josh is suffering from schizophrenia just like her brother. The DSM-V (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria for the detection of schizophrenia include identification of two or more of these following symptoms: delusions, hallucinations, catatonic behaviour, disorganized speech and other negative symptoms (Berendsen et al., 2018). Mezquida et al. (2018) stated that use of marijuana and consumption of uncontrolled alcohol might be associated with the development of severe anxiety and depression. Josh also had previous reported cases of depression and anxiety according to the case study and this further increase the vulnerability of developing other mental health complications. Mezquida et al. (2018) further highlighted that tendency of hallucination is common among the people who are addicted needle-based drugs or intravenous drugs. However, the case study fails to highlight any significant schizophrenic symptoms in Josh.
Impact of mental illness over self and family
The people who are suffering from psychological complications are more likely to suffer from poor-quality of life (Adhvaryu, Fenske and Nyshadham 2019). Six different domains of mental health and well-being are hampered among the people who are suffering from complex mental illness. These six different domains include ill-health, poor self-image, decrease in the level of autonomy, a sense of belongings, decrease in the level of engagement, decrease in the level of optimism in life (Adhvaryu, Fenske and Nyshadham 2019). Overall Ellicott et al. (2019) stated that the generic measures fail to address the complexity of the overall quality of life among the mental health patients and the condition becomes more significant when the person suffers from substance abuse.
The mental health complications of a person also cast a significant impact over the mental health status of his or her family members. The mental illness of one of the family members, becomes the primary focus of the rest of the family members. The family members have different perceptions towards mental illness and its problems. They also suffer from conflicts among other family members. The common impact of the mental illness over the family members includes frustration depression, helplessness, guilt, loss along with compassion fatigue (Ellicott et al., 2019). In case of Alice, it can be said that she is worried about her son’s health such that contacted her local Glenauri Child and Youth Mental Health Service. She is frightened she due to aggressive behaviour of Josh and at the same at worries that Josh is with bad crowd. Josh’s brother Daniel (19 years old) has moved out of the home due to the nuisance created by his Josh.
Depriving a person’s freedom: Justification
Theoretical dilemma
The effects of substance use disorder (SUD) are experienced by the entire family. The family members hold significant information regarding how SUD has developed. In this case, Alice is aware of the illicit drug abuse tendency of Josh. The family members cast a significant positive and negative influence on the overall treatment of this disorder. This can be explained by the family systems theory and attachment theory. Attachment theory states that having parents with SUD, inflicts the children (even during their minor age), to develop the same disorder (Lander, Howsare & Byrne, 2013). This concept is true in case of Josh. Alice drinks and smoke and so is Josh at the age of 17 and Alice has no problems with the same. Families with SUD have children who struggle with their emotional and behavioural problems. Josh also had certain complex emotions as he tries of contact his biological father and is unable to manage his temper. Family systems theory states that n individual cannot be fully understood or treated without first understanding the family (Lander, Howsare & Byrne, 2013). So in order to understand the Josh, Alice needs to be studied in detail. Thus restricting Josh first from executing personal independence is not an option; at first Alice needs to be studied in detail.
Deprivation of a person suffering from the mental health complications from freedom is justified when the person has substance abuse. Allowing persons with SUD to stay free under comprehensive freedom might inflict harm to others. It might also increase the chances of spread of the substance abuse among rest of the family members or friends. Substance abuse is a detrimental lifestyle habit and it increases the tendency of developing other physiological and psychological complications. So in order to avoid the chances of spreading of illicit drug use among others and to decrease the level of harm over others, restricting the person or confining the person is justified (Borsboom, 2017).
Ethical dilemma
According to the ethical theory of beneficence, it is the duty of the nurse is to promote good. Alternatively it can be said that the action of nurse must be designed in such a way that it promotes the overall betterment of a person (Zwitter, 2019). Restricting the autonomy of Josh and keeping himself under the confinement might increase the level of anger and thus increasing the attitudes of self-harm. Padmanathan et al. (2020) stated that people who are suffering from substance abuse are at the greater risks of developing suicidal tendencies in comparison to the general population and the tendency increases when the people with substance abuse are kept in confinement.
According to the ethical theory of non-maleficence it is the duty of the nursing professionals to act in favour of the betterment of everyone. Alternatively, it can be said that ethical theory of non-maleficence helps in promoting the good for the mass (Zwitter, 2019). Thus keeping Josh in confinement and restricting him to execute the personal independence will help to restrict his destructive behaviour and thereby helping to reduce his level of harm over others. Keeping Josh in executing personal independence will also restrict him from injecting intravenous medication and thereby reducing the level of harm over Josh (Stein & Manyedi, 2016).
However, to lawfully deprive a person of freedom is against the ethical morale of utilitarianism. This ethical theory mainly advocates or promotes the overall happiness of a person. The theory strictly restricts the actions that cause unhappiness or harm (Zwitter, 2019). Thus in relation to this theory, it can be said that any restriction to release Josh in public or violating his autonomy might impose harm or reduce his level of happiness thus, violating the ethical theory of utilitarianism. However, the theory of utilitarianism is directed towards making social, political and economic aims for the betterment of the society (Zwitter, 2019). In relation to this aspect of the theory, it can be said that confining Josh will help his neighbours to stay in peace and will also given his mother a sense of relief and thus not breaching the ethics of utilitarianism.
Legal dilemma
Drug law in Australia are complex. Some of the drugs law are federal while rest of the laws are territory or state based. The legal drugs in Australia are alcohol, caffeine, nicotine and other over-the counter medications and prescribed rugs. However, the consumption of the drugs and alcohol is only permissible for the older adults (Australian Government Department of Health, 2020). Here Josh is still a minor (17 years old) and thus can be regarded as a punishable offence. Thus restricting Josh from consumption of alcohol by reducing his level of personal independence is justified under the legal framework. The illegal drugs in Australia include amphetamines, cannabis (marijuana), heroine and ecstasy (MDMA) (Australian Government Department of Health, 2020). Thus consumption of marijuana by Josh is illegal and restricting his personal independence and forbidding him from taking medications is justified. Josh also suffers from illicit drug abuse. This further justifies taking the personal independence or freedom of Josh and lawfully deprives him from conducting illicit drug abuse.
Mental health assessment recovery framework
The mental health policy framework that coincides with the scope of this case study is National Framework For Recovery Oriented Mental Health Services. The National Framework For Recovery-Oriented Mental Health Services is endorsed by the Australian Health Ministers Advisory Council (AHMAC) and was launched on 2013 (Australian Government Department of Health, 2013). According to this framework, the recovery of the mental health status of a person is dependent on their socio-economic determinants of health and psychological state of mind. According to the case study, Josh had tried to reach out to his biological father who is an Aboriginal but his mother refused to do the same. Josh also identifies himself as an Aboriginal but he is not concerned with the local aboriginal community and culture. Carpenter and Sly (2018) stated that aboriginals mainly reside under the poor socio-economic determinants of health however, since Josh is out of touch with his father and lives with his mother and his partner, social determinants of health was not a concern for Josh. However, Josh’s psychological state of mind is poor as he is more concerned about contacting his biological father and restricting him to conduct the same is further forcing him to indulge in substance abuse. Thus in order to promote proper recovery of his mental health and overcoming substance abuse, the first support that he needs is family support. Alice must allow Josh to interact with his father once. If she is not willing to do the same due to the criminal history of his biological father, she must also explain Josh the concern in detail. LeCloux et al. (2017) stated proper support coming from family members, helps to reduce tendency of conducting substance abuse. Another aspect of the recovery oriented mental health policy approach for the promotion of mental health of Josh will be utilization of the personal recovery resources (Australian Health Ministers’ Advisory Council, 2013). Proper allocation of nursing professionals, followed by effective counselling conducted by the mental health nursing professional will help Josh to understand his personal resources and same will be utilized by him in order to recover from mental health complications (Jones, 2018). Proper use of the support networks is also important in order to promote effective mental health while reducing the chances of substance abuse. The friends of Josh “bad friends” as stated by his mother thus availing help from his friends in order to overcome his complex mental health condition and substance abuse will not be an option. The recovery plan must be designed based on the uniqueness of the individuals and this will help to improve the overall quality of care (Australian Health Ministers’ Advisory Council, 2013). However, designing of cultural competent plan will not be a case for Josh, as he does not connect with the aboriginal culture. The real choices of the service users must also be given preferences and in this case it would be contacting his father.
Collaborative mental health care plan
Trani et al. (2016) stated that community-based interventions are effective in reducing the overall mental health-related complications among the individuals or group of individuals. This is mostly done in groups and thus helping to increase the overall rate of participation of the mental healthcare service users. The first community-based intervention for Alice will be education and spreading awareness among her about the ill effects of substance abuse and alcohol consumption. She will also be advised to reduce her smoking rates and alcohol use while forbidding the tendency of substance abuse in his son. The health awareness will be done by community nurse. Patterson, Edwards and Vakili (2018) stated that family awareness help in comprehensive promotion of health while helping to increase the level of therapy adherence. The second community-based intervention would include conducted a stringent mental health counselling with Josh and to understand the underlying reason for substance abuse and destructive attitudes. This will help in framing of person centred intervention. This will be executed by metal health nurse under the presence of community health nurse. Josh will be asked to take part in the group based activity like physical exercise programs. Hanlon, Morris and O’Sullivan (2018) stated that regular practice of the mild to moderate physical activity helps to reduce the tendency of smoking and helps to reduce the withdrawal symptoms of marijuana. However, Kim and Harley (2019) that people who are on intravenous drugs are advised to stay in rehabilitation unit for a certain period of time in order to reduce withdrawal symptoms. Keeping Josh in the rehabilitation unit will require the permission of his mother as he is still a minor. In order to reduce his level of destructive attitude, he will be trained in anger management. Anger management can be undertaken by the use of the music therapy. Proper use of the music therapy under periodic interval helps in reducing anger or to effectively manage temper. Regular counselling of Josh along with community-based participation will help him to recover from his tendency of substance abuse.
Conclusion
Thus from the above discussion, it can be concluded that Josh is suffering from certain mental health complications and he has also developed intoxication towards illicit drugs. The ethical principle of non-maleficence goes in favour of restricting Josh towards executing personal wish. The Australian legal aspect also goes in favours of restricting Josh as he consumes marijuana that is illegal in Australia. Though alcohol is legal in Australia, but he is a minor and thus considered to be violation o the law. The theoretical perspective also states that in order to improve the comprehensive health and well-being of Josh, he must be forbidden to execute personal independence as he is also causing harm to others. The community-based health interventions include family-based education followed by counselling to Josh in order to identify his actual mental health complication. Social participation and regular practice of yoga will help to reduce the withdrawal symptoms. At lat the recovery oriented mental health approach can be effectively used for improving overall health and well-being of Josh throughout his life-span.
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