David case study

1
David case study

• Michael Hendon MH, Alexander Beer OT, Nicola
  Martin OT, Lynsey Virgo OT and Diane Ivory OT

What underlying causes or factors could account
for the psychological manifestations and
behaviours identified. Fear of authority of
persecution from society threats from gangs to
keep quiet. Become psychotic as a result of past
experiences e.g. physical/sexual/verbal/psychologi
cal abuse in childhood or whilst living rough.
What underlying causes or factors could account
for the physical manifestation identified.
Bleeding could have been attacked self harm
could be alcohol related falls painful feet.
Undernourished lack of food/money
malnutrition alcoholism. Cold hypothermia
lack of warm clothing/blankets no home
malnutrition. Unkempt lack of personal
hygiene/place to wash/reason to wash safety.
Feet alcohol related neuropathy,
gangrene/necrosis trench foot risk of falls
muscle atrophy/weakness in legs.
2
What physical health issues could be associated
with homelessness. Malnutrition poor feet
hypothermia poor teeth, skin hair condition
respiratory problems muscular skeletal
conditions trench foot wounds alcohol
ketoacidosis food poisoning poor eyesight
dehydration infections. What mental health
issues could be associated with homelessness.
Paranoia low self esteem alienation from
society depression anxiety schizophrenia
drug/alcohol dependence alcoholic
hallucinations. What social and societal issues
could be associated with homelessness. Poverty
abuse loss personal/employment victim/cause
of crime run away isolation from family and
friends history of being in care bankruptcy
catch 22 no job no home GP registration. How do
you communicate with someone who is displaying
difficult and challenging behaviour? Do not
directly challenge with eyes appear relaxed,
without passive demeanour. Be genuine and warm
take your time and do not attempt to rush
listen speak slowly and clearly maintain large
personal space encourage patient to talk. What
strategies could you adopt to win Davids
confidence? Use of above to gain his confidence,
so that he will trust you and proceed from there.
Dont offer more than you can actually deliver.
Start with small things like offering a hot drink.
3
How could you obtain consent when someone is
reluctant to cooperate with what you are trying
to do? provide them with information to persuade
them that what you are doing is for the best.
They may be sectioned under the mental health
act. What information is needed about David? How
might this be obtained, and by whom. Past medical
history past mental history family history
presenting conditions medical history. Try to
ascertain if there is any chance of contacting
family or carers. Find out where David came from
original to try and trace GP. Maybe known to
police, have a criminal record police may have
information about David. What are the
advantages and disadvantages of using self
reporting when gathering information.
Disadvantages peoples memories of events can
cloud through time or be exaggerated. In Hilda
Peplaus insightful words people make themselves
up as they talk. Storytelling acts as an
indirect view of their experiences and as such
may not be accurate or a true account of events.
Advantages straight from the horses mouth!
Therefore an element of heartfelt truth. Although
this may not be a true account of what has
actually happened to him it will give an insight
into his mental state.
4
How do you gain information about a potentially
sensitive aspect of someones life of lifestyle?
Gain the patients trust and make them feel secure
and confident about talking to you. What other
factors and issues could be associated with
Davids circumstances. Problems with authority
doctors/white coats. May not trust medical staff
due to past experiences. Could be in trouble with
the police. Drug taking. How could David have
accessed health and other public services without
getting arrested or admitted to A and E as the
only way of getting into the system? Street
outreach teams make contact with the homeless in
areas that they are known to sleep as a part of
the government policy of targeting the homeless
to offer services. What might now happen to
David? Prioritise your perceptions of his need
into short, medium and long term strategies.
Short medical treatment for head injury and
feet assessment of mental health needs
stabilise abusive and threatening behaviour
health referrals dietary needs and
accommodation. Medium reintegration into
society, living independently, personal hygiene
and day to day tasks, alcohol detox. Long job
skill training, social services and community
support, alcohol independence.
5
Which health and social care professions have the
potential to be involved in Davids journey, and
what might be their contribution? GP continuing
care with medication and health issues. Nurse
practitioners treatment of feet and other
illnesses. Dentist for dental hygiene.
Podiatrists for feet care. Mental health team
for the mental health needs that David requires.
OT for rehabilitation. Social workers for
benefits and housing issues. Drug and alcohol
counsellors to treat problems. What other
agencies and resources could also be utilise to
help meet Davids needs. Housing officers. Home
liaison people to get David back in touch with
his family and help him to be reintegrating David
to society to meet new friends. What could be the
potential advantages and disadvantages of
multi-professional and inter-agency working in
this situation? Advantages multi tasking
services should in theory be able to provide
David with everything he needs in one go in one
package. Disadvantages is the infrastructure
there for them to liase between each other, or is
David going to be let down and therefore risk
relapsing. Need to encourage staff to accept
responsibility for Davids care and not expect
other parts of the team to pick up the pieces.
6
What challenges might David encounter on his
journey, and how could these be overcome. Alcohol
David will have money when he gets a job and
will therefore have access to pubs/alcohol in
supermarket, money combined with stress from day
to life could cause a relapse AA counselling.
May feel alienated on integrating back into
society/day to day living day centres, OT, life
skill training. Stressful life occurrences e.g.
redundancy, bad day at work, may lead back to
alcohol/mental health problems need for
counselling. Difficulty in getting a job no
work history, job centre.