Assignment C – Navigating the system to achieve the best outcomes

Building from the scenario you chose in assignment task B (Appendix A – GRIEF ). Assume that the person has a minimal financial resources (and thus does not have the means to access private health care):

Assignment C Rubric ( Navigating the system to achieve the best outcomes )

1- Criterion; Construct a care plan which is recovery focused and will comprehensively address the young person’s problems accessing at least two non-government organizations (NGO’s) or programmes available within the primary care setting.

Mark; 55%;

Exception knowledge demonstrated of NGOs & programmes, how they operate, referral pathways, how they are funded and what treatment is provided. Goals SMART and likely to address problems. Specific enough to be useful. Highly relevant resources identified.

2- Criterion; Barriers, obstacles and pathways through stepped care.

Mark; 20%

Exceptional understanding of ‘stepped care’ demonstrated. Anticipated trajectory of the person is exceptionally well described with inclusion of a very detailed set of outcomes that might be expected in recovery. Obstacles and barriers to recovery are comprehensively described as is access to addition tiers of support if needed

3- Criterion; Summary. Construct a letter.

Mark 15%

Comprehensive overview of critical health issues. Clear and succinct plan of care and recommendations to the GP.

4- Critirion; Writing Spelling & Grammar Referencing

Mark 10%

Exceptionally clear, crisp and coherent style. Exceptionally well organised. Completely free of grammar and spelling errors. All citations follow required style.

FEEDBACK on case studies of Anton and Cat. Physical health care in mental health.

The assignment starts with the case study of Anton. The issues where Anton are presenting with are first addressed. Unfortunately, this reads too much like an iteration of the case scenario from the Assessment Guide. It is also really short in light of the 30% weight that is attached to the first assessment task. You should have focussed on the main physical health issue that is present in Anton’s case — the risk of developing metabolic syndrome — and how the other issues are impacting on this; one of the most important is the use of Risperdal, so we wanted you to think carefully about the impact of this antipsychotic on the risk of developing metabolic syndrome as well as its effect on potency. 

You make a strong plea in the care plan for the need of optimising physical exercise and healthy nutrition. The directions that are shared here are sound and supported by evidence from the literature. What is missing here, however, is a discussion on how these would precisely halt the development of metabolic syndrome. Similar to the first section, there is no reflection here on what should be done with the administration of Risperdal; should this antipsychotic be continued, or should we stop it or lower its dose, or consider a different antipsychotic, so that the risk of metabolic syndrome would be mitigated and Anton not any longer experiences impotency…?

A referral to an exercise therapist and a dietician would indeed benefit Anton’s physical health, as well as a sexual therapist to optimise his sexual life. However, again nothing is considered here regarding the use of Risperdal and which professional consequently should become involved.

Anton would indeed benefit from support to get over his cannabis use. But just one support group for this suffices, so why not considering as a second support group one that could help Anton getting his life back on track in terms of employment or education?

The outcome scenario provides some idea what could happen to Anton in case his care plan would be adequately implemented.

Now over to the case of Cat.

As this whole unit has been on physical health of people with a mental illness, we expected that you would have a primary focus on the physical health issues where the people in the case studies present with. In the case of Cat that was her disordered eating behaviours. The first section should have revolved around that: what underlies these behaviours and how are the other health issues impacting upon. Vital in this case was giving insight regarding weight and BMI: how much does Cat weight now, what is her BMI, and what does this BMI tell us (a little over 17, meaning that she is in the category of ‘moderately underweight’ and that therefore treatment in the community should be favoured over hospitalisation).

In light of the purpose of this assignment, we were not interested in how to manage the mental health of the people form the case studies. The text spent on talk therapy should have remained limited to one or two sentences. The focus should have been put on how Cat could be helped in overcoming her eating disorder, by first having eye for how her immediate physical health issues should be targeted. Her physical health is at a direct risk due to binging and purging (which actually can be life-threatening in case she continues with this) and electrolyte balance; this should have been discussed first. Then the focus should have been put on how Cat could be assisted with gaining weight so that her BMI would get in between the “healthy” parameters once again. Once this has been done, then the focus could be switched to how Cat could get her life back on track, and only then a form of psychotherapy can be brought in.

Text spent on the professionals to who Cat should be referred to remains too limited. Just a community therapist (what is such a profession about; a social worker….?) and psychologist would not suffice. She should be referred to a GP for monitoring her health and the introduction of a dietician would help her in gaining weight and maintaining a healthy diet.

Community support in the form of assistance to overcome methamphetamine use would be a good choice as well as assistance for eating disorders. 

The outcome scenario should have had a focus on how Cat could be assisted in overcoming her disordered eating behaviours.

Writing and referencing are done competently; just a few hiccups here and there which are identified in inline comments.

What this has resulted in, is a weak discussion surrounding the plan and referrals.