Studentnamesusann Treston

StudentnameSusann Treston

Student numberS0158048

Course codeSOWK13012

AssignmentAssessment 1

TopicOnline Group Discussion

Word Count 150 words per entry

LecturerMegan Humphris

Due date5 August 2011

What were some of the symptoms that Millie demonstrated or discussed by family members and what impacts did they have on her family relationships?

Millie demonstrated a number of psychotic symptoms, where psychotic refers to the presence of certain symptoms such as ‘delusions, any prominent hallucinations, disorganised speech or disorganised or catatonic behaviour’ (APA 2000, p. 297). Millie’s psychotic symptomswere prominent delusions, an essential feature of paranoid schizophrenia typically persecutory or grandiose organised around a coherent theme (APA 2000, p. 313). Associated features include anxiety, aloofness and argumentativeness; where the individual may demonstrate a superior patronising manner and extreme intensity in interactions. Millie’s interactions with her family were illustrative of these characteristics demonstrating her being out of touch with reality and paranoid about others activities. Her behaviour impacted upon the family in the following manner: negatively and destructively in the form of family dysfunction and the creation of interpersonal tension, anger, violence, sadness and relationship fragmentation. Additionally, there were the productive impacts of developing resilience, strengths and solutions through adversity.

(147).

References

American Psychiatric Association 2000, Diagnostic and statistical manual of mental disorders, 4th.edn., Text Revision, American Psychiatric Association, Arlington.

What could have Alan, other relatives or neighbours have done to help?

Alan may have sought assistance and advice from a qualified person, generally a GP early in the illness when Millie’s behaviour changed. Partners that have some education about the illness and what to expect are in a more favourable position to be supportive and also take care of their own needs (MeuserGingerich 2006, Help Guide 2011). It can be difficult to know how to respond to someone with schizophrenia, their beliefs and experiences are very real to them, when criticized or pressured people with schizophrenia usually do not get well and may get worse. Supportive relationships, telling them when they are doing something right are the best way to help them move forward (National Institute of Mental Health 2009). Often people with schizophrenia resist treatment due to lack of insight, being respectful, supportive, and kind without tolerating dangerous or inappropriate behavior is the best way to approach people with this disorder(NIMH 2009).

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References

National Institute of Mental Health 2009, ‘Schizophrenia’,

Help Guide 2011, ‘Helping a person with schizophrenia’,

Meuser, K & Gingerich, S 2006, The complete family guide to schizophrenia, Guilford Press, New York.

Standing in the shoes of Millie’s children, informed by theories of child development how do you believe Susan and Tina understood their mothers Illness?

Research indicates children of a person with mental illness have increased risk of developing negative coping strategies which differ according to the child's developmental stage. It is during infancy healthy and secure attachments are formed and influencedby interactions (Australian Government 2004). For example, babies may be withdrawn and less responsive, primary school children may have low self-esteem and be anxious, and adolescents may experience low self-confidence, isolation and a sense of responsibility also experiencing emotional loss when the parent may be physically but not emotionally present (Schizophrenia Fellowship 2008, Somers 2007). Susan and Tina are likely to have understood their mother’s behaviour as normal as they had little comparison until they began to have more frequent contact with their father and his new family. At this stage, the girls would have understoodthat their poor home life was directly related to their mother’s behaviourbut had no idea their mother was ill.

(153)

References

Australian Government 2004, Department of Health and Aging, ‘Principles and actions for services and peoples working with children of parent with a mental illness’, viewed 29 July 2011,

Schizophrenia Fellowship 2008, ‘Children of parents with mental illness’, viewed 29 July 2011,

Somers, V 2007, ‘Schizophrenia: the impact of parental illness on children’, British Journal of Social Work, vol. 37, pp.1319-1334, (online Informit).

How could mental health providers have done more to protect Susan and Tina?

Mental Health workers can play key support roles in the care and protection of children with a mental illness where there are concerns regarding the child’s welfare, by assessment of the short and long term effects of the illness on the children. Family capacity can be increased by advocacy and service provision, assisting children to keep well by having access to factors that increase resilience such as a contact person when there is a crisis, developing opportunities for community and peer support and to develop age appropriate problem solving skills. Where there are safety and welfare concerns mental health providers could work collaboratively and pro-actively to support the family and by determining parental capacity and develop a safety and monitoring plan for the children.

(124)

References

AustralianGovernment 2004, Department of Health and Aging, ‘Principles and actions for services and peoples working with children of parent with a mental illness’, viewed 29 July 2011,

What role has Susan and Tina played in ensuring Millie’s wellbeing and safety?

Hi Trudy, further to your discussion,

As Susan and Tina became their mother’s guardian they were able to more successfully navigate the system and advocate on behalf of their mother with respect to access to information, medication compliance, consistency of treatment and community inclusion, all important factors in maintaining wellbeing. Recovery involves management of symptoms and dealing with the social consequences associated with mental illness. Having access to meaningful social relationships is an important part of recovery towards developing a quality of life for people with psychiatric disabilities (Farone 2006). Susan and Tina as guardians played a major role in their mother’s safety by facilitating Millie’s placement in the group home (after 47 home moves in 20 years) offering a stable residence where she could not be evicted. This stability contributed to her wellbeing and inclusion as she was able to now develop social relationships through the residence and employment and concentrate on her goals.

(149)

References

Farone, D 2006, ‘Schizophrenia, community integration, and recovery: implications for social work practice’, Social Work in Mental Health, vol. 4, s.4, pp21-36 (online EBSCOhost).

Why doesn’t Millie believe she is ill?

Individuals with schizophrenia, in the majority of cases, have a persistent lack of insight that they have a psychotic illness (American Psychiatric Association(APA) 2000). Poor insight in psychosis has been described as a lack of awareness of having an illness, the consequences and need for treatment in addition ‘lack of insight’ appears to be resistant to medication (Amador 2006). Studies have shown lack of insight has continued despite patient awareness of their diagnosis; for example,even after diagnosis, patients were unable to see obvious signs of their illness despite everyone around them recognising symptoms such as thought disorder, mania and hallucinations (Amador 2006).Lack of insight has been attributed to frontal lobe pathologyand neuropsychological deficits (Amador 2006) and is indicative of increased patient relapses, involuntary hospital admissions, psychosocial functioning and medication non-compliance(APA 2000). Millie doesn’t believe she is ill as she lacks insight, which is symptomatic of the illness of schizophrenia.

(154)

References

American Psychiatric Association 2000, Diagnostic and statistical manual of mental disorders, 4th.edn., Text Revision, American Psychiatric Association, Arlington.

Amador, X 2006, ‘Poor insight in schizophrenia: overview and impact on

medication compliance’, viewed 29 July 2011,

What factors do you think ultimately influenced Millie to take medication?

Hi Jeannie, I would like to add,

About one third of people with schizophrenia stay on medication because others think it is important (Weiden 2004), the supportive, hopeful and optimistic influence of Millie’s children may have influenced her decision to take medication. Additionally, many aspects of a therapeutic relationship, continuity, stability, nurturance and authority have provided consumers with incentives to comply. Also Millie was settled and content in her new group home where the twice daily medication regime was a requirement, soalthough Millie may have believed she didn't need the medication, she did need to take the medication to stay at the residence so that was her incentive.

(102)

References

Weiden, P 2004, ‘How to help someone who stops taking their medicines’, viewed 30 July 2011,

How might Millie’s life have been different if she was engaged in treatment at the onset of her illness?

Hi Jeannie, I agree with your comments and would like to add,

According to McGorry (2005, p. 4), in 90 percent of cases treatment of the first episode of schizophrenia results in full or partial symptom remission. If treatment is delayed there is considerable psychosocial damage and increased possibility of active neurobiological changes comparative to the extent of the delay. Upon examining Erikson’s theory of psychosocial development, Millie’s schizophrenia has affected her adulthood ability to form intimate loving relationships resulting in loneliness and isolation, in middle adulthood, her generative ability was compromised leading to stagnation and lack of accomplishment, with treatment she currently appears to be negotiating a successful life maturity stage, exhibiting fulfilment and wisdom rather than despair (Singh 2007, p. 30). For Millie, earlier treatment may have implicated completely different life stage outcomes, for instance positive family relationships, successful marriage, community inclusion and personal development.

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References

McGorry, P 2005, ‘Royal Australian and New Zealand college of psychiatrists clinical practice guidelines forthe treatment of schizophrenia and related disorders’,Australian and New Zealand Journal of Psychiatry,vol. 39, pp. 1-30 (online Informit).

Singh, B 2007, ‘The psychoanalytic or psychodynamic approach’, in Meadows G, Singh B & Grigg M (eds), Mental health in Australia: collaborative community practice, 2ndedn, Oxford University Press, South Melbourne.

If Millie shared with you that she had grown up in an Indigenous-European-Australian family what questions would that raise for you in relation to her professional care?

Hi Bronwyn, I would like to further your discussion by adding,

In cross cultural settings, clinicians should be mindful of the impact of cultural difference and the broad understandings of health and sickness, assessment, clinical presentations and treatment (McGorry2005. p. 6).For example positivesymptoms should be excluded from what could be a culturally informed experience and a negative symptom may be attributed more to social disadvantage complicated by substance use. McGorry (2005, p. 4), further advises that miscommunication can compound difficulties in assessment and notes the importance of utilising collateral cultural informants. There is a range of social, cultural, educational and family backgrounds within one culture and relevancy for one group may not be relevant for another group. For Millie’s professional care it would be important to determine that the tools employed for diagnosis and treatment are appropriate for her cultural background (AIHI 2011).

(135)

References

Australian Indigenous Health Infonet 2011, ‘How is culture important to understanding mental illness’, viewed 30 July 2011,

Comparing beliefs about schizophrenia in the past with the present - is the pessimism that often accompanies schizophrenia justified over the long term? Millie has been in the same home and has held a job for more than 2 ½ years. What was Millie’s contribution to her own progress?

Hi Nicole, I would like to add,

Millie’s contribution to her progress was also influenced by her gender and absence of negative symptoms; being female has been predictive of positive recovery outcomes, related to gender roles and women’s social functioning capacity in comparison to males.The type of person she was before she became ill (premorbid adjustment) is a predictor of recovery (Birchwood & Jackson 2001). Although Millie thought she has never been ‘right’ she was able to control her interactions (when vistors came to the home and close uni friends had no inkling of her illness) which indicate her capacity for controlling her behaviour. Additionally, the establishment and achievement of self determined goals (employment, savings) goes a long way to positively reinforce her contribution and continuance of progress. Millie did not take drugs or alcohol, co-morbidity strongly increases relapse probability, therefore by not abusing substances she has lessened relapse likelihood (Bennett 2007).

(146)

References

Bennett, C 2007, ‘Outcome of schizophrenia’, in Meadows G, Singh B & Grigg M (eds), Mental health in Australia: collaborative community practice, 2ndedn, Oxford University Press, South Melbourne.

Birchwood, M & Jackson, C 2001, Schizophrenia, Psychology Press, East Sussex.

Excellent Susan

25/25

You have an excellent knowledge of mental health issues and i was particularly impressed how you were able to apply this to the dvd. Well referenced, with credible references.

Look forward to your next assessment.

Susann TrestonPage 1 of 8

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