The identification of the following specific mental health conditions is based on the case study of information provided and is not a diagnosis, as it is not within the social work role to provide medical judgement as they are not qualified diagnosticians. The World Health Organisation (WHO) (2016) state that multiple diagnoses may be logged according to the ICD-10.
Jane’s daily life and functioning have been effected as there is disturbance in the three main areas related to mental ill health; her thinking, behaviour and mood. These symptoms could indicate schizophrenia (F20) (WHO, 2016). She is experiencing drastic behavioural and speech changes, as she is talking, often loudly to herself, wandering around the house at night, and her emotional expressions are also impaired as she is appearing distant and agitated. Additionally, she is not responding to the care needs of Sam or interacting or taking an interest in him.
Jane’s symptoms may also be indicating a depressive episode (F32) (WHO, 2016). Considering the biopsychosocial approach; although information is limited on what is known about Jane’s parents and genetics there may be a genetic link to schizophrenia and the depressive episode. Physiologically, Jane experienced sexual abuse during her childhood from her step-brother which would have impacted hugely on her mental wellbeing into adulthood. Social factors influencing Jane’s situation, would be her lack of contact with her mother and father, and no contact or trace with Sam’s father, resulting in no support whilst parenting Sam. Moreover, she has expressed feelings of blame and regret, regarding the distant relationship with her parents, after they never believed her allegations of sexual abuse. This could be coupled with feelings of unworthiness and contributing to low self-esteem. In addition, the living arrangements may also mean that Jane could be feeling isolated, they have lived there for three years but there is no mention of Jane mixing socially with any friends or neighbours. According to the study, there is no evidence of Jane having any income or financial support, although she has attempted to access child maintenance for Sam, this has been unsuccessful, this could be leading to contributing to her mood being affected as she worried about money.
Bremner and Marner (1998) discuss the consequences of trauma which could as loss of interest in life, irritability and depression. These are all apparent from the information surrounding Jane’s situation. She is not caring for Sam and has lost interest in her daily life, her agitated and distant behaviour and low self-esteem from lack of belief from her parents around the sexual abuse claims. According to Lange, Condon and Gardiner (2013), sexual abuse experienced during childhood and have enduring effects on mental health and can affect parenting abilities resulting in emotional detachments. The evidence presented may suggest that Jane could be showing symptoms of post-traumatic stress disorder (F43.1) (WHO, 2016, p. 103) “which is a response to a significant life of a threatening nature which can cause pervasive distress.” Jane’s wandering around at night, may be a sign of insomnia which can be another predisposing symptom.
Question 2: Identify and discuss at least two current factors to do with Jane and Sam’s situation that you consider most pertinent to a social work assessment of the case; please explain the reasons for your choices.
Holistic assessment is key within mental health social work practice. Under s. 9 of the Care Act 2014, Jane has a right to have her care and support needs assessed. The current factors that could be pertinent to assessing Jane and Sam’s situation would be exploring the social and environmental contributing factors to the stress Jane is experiencing. The psychological impact of sexual abuse, may be influencing her lack of daily functioning, alongside her lack of social support networks from her parents and family unit. According to Greene (2017), from the ecological systems theoretical perspective, which focusses on the mutual interaction of individuals and their surrounding environment. The assessment process should look at the environmental factors which could be stress factors for the Jane; such as housing, finances and interpersonal relationships with her parents and son Sam. From the evidence, it is apparent that Jane, has limited contact with her parents and there seems to be no indication of friendship groups for social support.
Jane’s lack of interest in daily life and her deteriorating functioning, alongside not meeting her son’s Sam’s basic care needs, may suggest (although not stated in the case study) that Jane could be at risk of self-neglecting. The use of psychodynamic approach in addition to the biopsychosocial model, to gain a deeper understanding of an individual’s behaviours is essential, when past traumatic events have occurred which have led them to be unable to maintain their surroundings or unable to meet their or their dependants basic care needs (Braye, Orr and Preston-Shoot, 2014). Consideration needs to be given to her son Sam’s welfare, even though the primary focus of the assessment is Jane’s needs. Under s. 11 of the Children Act 2004, social workers have a duty to safeguard and promote the wellbeing of children. Smith (2004) suggests that parental mental health can disrupt an individual’s capacity to parent which can have a negative impact on the child’s outcomes. Evidence from the case study suggests that Sam has been arriving at school late and unaccompanied, which if this continued could be a risk to Sam’s personal safety and educational wellbeing.
The evidence further suggests, that Jane is currently receiving support and treatment from mental health services, and this element should be explored, as this could be an additional stress inducing factor, if she has negative feelings towards the support being provided. The type of support or treatment Jane is receiving cannot be identified, although it would be important as this assessment is based on her needs, to ascertain the treatment involves medication. If so, determining the appropriate dosage would be essential, as misuse could put Jane at potential risk of overdose or withdrawal. Adopting a multi-agency approach, by sharing information about Jane’s medication is crucial, as the side effects of ant-depressants include, agitated behaviour and insomnia, which links in with the traits Jane is experiencing (Darton, 2016).
Question 3: Discuss a plan of action, based on the current situation as described above. Include two aspects / approaches of effective social work practice with Jane and Sam that you consider most important in intervening in this case.
The safety of both Jane and Sam are of paramount importance, therefore working to manage any risks which could increase the likelihood of harm to both Jane and Sam is essential when forming an action plan (Sam attends school so his safety is presumed at this current time)
Multi-agency working needs to be exercised when co-ordinating risk management when working with service users with mental ill health (National Institute for Health Research, 2012). Information sharing should be an active process between Sam’s social worker, Sam’s school Jane’s mental health social worker and the family support worker.
Tools to assess risk, such as; the Working with Risk/Clinical Risk Management Tool (CRMT) which highlights relevant risks and contextual factors. This tool focusses on risk of violence, suicide or self-harm and self-neglect and vulnerability. It can be used to aid Jane’s understanding of her condition, along with exploring the social, environmental and protective factors such as family relationships which could be key in supporting Jane (Department of Health, 2009). Sam has good relationships will school staff and has a good group of friends which are protective factors for him in the situation.
The evidence does not suggest Jane is self-harming, suicidal or demonstrating suicidal behaviour, she may be at risk which increases her vulnerability, though there is a correlation between sleep disturbance and insomnia symptoms with heightened risk of suicide (Littlewood et al., 2017). Jane should be supported to take positive risks and manage her own decisions about her care needs. Jane’s capacity should be assumed, additionally the Mental Capacity Act 2005, justifies an individual’s right to make their own choices about their safety.
Assessing Jane under s. 2 of the Mental Health Act 1983 would be necessary if the risk assessment concluded that she could be a risk to herself or others. There is an emphasis on using the least restrictive option when deciding on treatment for an individual with mental ill health and must be in their best interests. If detention under s. 2 and hospital admission (must be voluntary by Jane) was required, s. 26 states that a nearest relative should be contacted, which would be Jane’s mother or father in this case. As the parent’s relationship with Jane could be a reason for the decline in her mental health, she would have the ability to appeal (Barber, Brown and Martin, 2016).
The assessment process and proposed action plan should be aiming to support Jane’s recovery. A plan should be established alongside Jane to motivate her to change her situation, whereby she sets her own goals and sets timeframes for achieving these targets. Jane would be going through the preparation, action and maintenance stages of the cycle of change; Prochaska and DiClemente (1983 cited in Miller and Heather). The three stages include, intending to take action to address the problem, active modification of her behaviour and finally displaying sustained change, so the previous behaviours are replaced. Use of the cycle of change model in conjunction with the recovery model (Hafal, 2016); is empowering Jane to self-manage her mental ill health. This is achieved by using the whole person approach which focuses on all areas of Jane life; including finance, parenting, education, accommodation and mental and physical wellbeing. This approach, coupled with Jane’s commitment to progress should promote her recovery.
Additionally, following assessment of her parenting capacity, which acknowledges the impact of Jane’s condition on her immediate family (Evans and Fowler, 2008). The recovery plan should include recognition of how she will meet Sam’s emotional and development needs. Information sharing with his children’s social worker as required and continuous liaising with the school, to ensure his educational needs are being met.