Mental health forms a significant aspect of human health because it determines the general health of a person. Mental illnesses are common disorders that affect how humans behave, think, or feel. Usually, people with mental illnesses exhibit unique behaviours, nurture strange thoughts, and have irritable emotions.
Depression, obsessive-compulsive disorder, social phobia, panic disorder, post-traumatic stress disorder, and anxiety are some mental illnesses that affect approximately 15% of the population in the United States (National Institute for Health and Clinical Excellence, 2012).
The severity of these mental illnesses varies from one person to another and the illnesses cause considerable long-term disabilities among patients. Since the severity of mental illnesses varies from one patient to another, some mental illnesses require emergency attention. Some of the mental illnesses that require emergency psychiatry services include psychosis, depression, substance abuse, and attempted suicide amongst other mental illnesses.
The emergency psychiatry services are important because they help in the diagnosis, treatment, and management of mental illnesses in time to avert further complications. In this view, this essay examines the case scenario of a patient with a depression who received emergency psychiatry services with the objective of discussing personal response and providing constructive reflection on management and outcomes.
Synopsis of Scenario
Dan is a prisoner who experienced mental problems and the prison officers brought him to the psychiatric emergency unit. He is a middle-aged man of 32 years. The criminal justice system found Dan guilty of assault and resisting arrest.
In the prison, Dan suffered from a mental condition because he had difficulties sleeping, hated the accommodation provided, felt angry about his prison condition, and was irritable. Although Dan had not undergone any form of surgery in the last two years, he experienced psychological problems at the age of 10 years, which prompted him to seek medical intervention from a psychiatrist.
During the arrest, Dan sustained a minor injury on the shoulder, which is complicated his mental problem. According to the scenario presented by the National Institute for Health and Clinical Excellence (2012), “a brief history shows that he has symptoms which fulfil the criteria for both anxiety disorder and depression” (p. 38). The scenario indicates that Dan had mental problems that require emergency psychiatry to enable him recover well.
During admission at the emergency psychiatry, Dan arrived while presenting a number of symptoms that showed that he was suffering from mental illness. In the physical examination, Dan was dressed smartly in casual clothes and had shaved his hair clean, which showed that he had the ability to groom well. Since Dan had sustained a minor injury on his shoulder, he complained about the pain.
In addition, the prison officers claimed that Dan was suffering from the pain in his shoulder because of the injury he sustained during the arrest. Oktay, Eken, Ozbek, Ankun, Eray, and Avci (2008), state that depression and anxiety increase perception of pain among patients.
However, Dan looked miserable, unhappy, and frustrated because he did not want to talk to the psychiatrists at the emergency unit. When asked what was wrong with him, Dan was reluctant to answer because he was confused and depressed. Hence, psychiatrists had to make appropriate diagnosis of his mental condition before providing the therapy.
The psychiatrists noted that Dan was suffering from a physical condition that complicated his mental illness. According to Dan, he was suffering from the shoulder pain, but psychiatrists were able to note the signs of depression and anxiety.
The psychiatrists questioned Dan about his current life and past life to establish the extent of the depression and anxiety. In current life, psychiatrists inquired about his marriage status, occupation, and living standard so that they could get insights about the present issues that are causing depression in him.
In the past life, psychiatrists did inquire about his social life during childhood and family life so that they could find out if current depression and anxiety has historical origin. Basing on the current life and past life, Dan confessed that he has been nurturing suicidal thoughts and has attempted to commit suicide on many occasions. To overcome suicidal thoughts, Dan used alcohol and drugs because they reduce depressive moods and decrease sleep problems.
The scenario of the Dan is appropriate for the emergency psychiatry because anxiety and depression are serious mental disorders that threaten the lives of patients. Depression and anxiety predispose patients to alcoholism, drug abuse, and eventually make them commit suicide.
Barry, Milner, Blow, Impens, Welsh, and Amash (2006) state that assessment of alcoholism and drug abuse is crucial among patients who are receiving emergency psychiatric services.
At the emergency psychiatric unit, psychiatrists employ a number of diagnostic techniques in diagnosing the major causes of mental illnesses so that they can provide specific interventions. Thus, the scenario of Dan is an important case study because it describes how psychiatrists handle cases of anxiety and depression amidst other complications that mask their diagnosis.
Response to Emergency Psychiatry
As a personal response to the emergency, when Dan arrived at the psychiatric emergency unit, I could not comprehend the nature of mental illness that he was suffering from because he appeared physically smart in his casual wear.
When he complained about the shoulder pain, I thought that Dan might have sustained a spinal injury that affected his psychological health. Dan looked sad, miserable, unhappy, and frustrated when he arrived at the psychiatric emergency unit escorted by the prison officers.
When I saw him, I empathized because I could not understand the mental condition that he was battling with because he was reluctant to speak. Hojat, Gonnella, Nasca, Mangione, Vergare, & Magee (2002) argue that, “the cognitive domain of empathy involves the ability to understand another person’s inner experiences and feelings and a capability to view the outside world from the other person’s perspective” (p. 1564). Hence, when I was empathizing with Dan, I was trying to diagnose his condition based on emotions that he presented to me.
Additionally, I observed how Dan had groomed because it did provide a clue about the nature of life he was living. From the way he groomed, Dan was a presentable person because he showed no sign of mental illness except that he complained about pain in the shoulder. Since the pain in the shoulder made him appear sad, unhappy, and frustrated, I inquired from the prison officers what was wrong with Dan.
The officers confirmed that Dan sustained a shoulder injury because he attempted to resist arrest. Furthermore, the prison officers said that Dan has been abusing drugs and drinking alcohol, and at times attempting to commit suicide. Stanley, Brown, and Hughes (2009) argue that people who experience suicidal feelings require emergency psychiatric services to save them from committing suicide.
Thus, suicide attempts made me believe that Dan required immediate psychotherapy to enable him to cope with suicidal feelings and attitude. At this point, I pitied Dan since I started to realize that he had so many psychological issues that prompted him to commit suicide.
Professionally, when Dan arrived at the psychiatric emergency unit, psychiatrists attended to him immediately. As a psychiatrist, I understood that Dan was suffering from a complex psychological disorder with comorbid factors responsible for his mental disorder.
At first glance, Dan looked sad, unhappy, and frustrated because of the conditions of the life, which clouded his mind. Since the prison officers brought Dan to the psychiatric emergency unit, it showed that he was a prisoner who lived under prison conditions of life.
Moreover, when prison officers and Dan claimed that Dan was suffering from shoulder pain, which was affecting his psychological health, I noted that the pain might have been just a comorbid factor that confounded or masked psychological disorder that Dan was struggling to overcome.
Bair, Robinson, Katon, and Kroenke (2003) argue that, “the presence of pain negatively affects the recognition and treatment of depression” among patients who have comorbid factors, as they complicate diagnosis of mental disorders (p. 2434). Hence, with the understanding that pain is a comorbid factor that complicates diagnosis of mental disorders, I examined other psychological attributes.
When I interacted with Dan, I noted that he was sceptical and shy, and thus was unwilling to share about his mental condition. Mistrust made Dan to live in denial because he did not want to admit that he was suffering from a mental disorder. Hence, to overcome the challenge of mistrust, I tried to create a good rapport with Dan so that he could open up and share his psychological issues.
Snowden (2003) advises psychiatrists to overcome mistrust, which is a barrier that prevents patients from sharing their experiences, for them to provide effective psychotherapy. After winning the trust of Dan, I inquired further about his current and past life.
The inquiry revealed that Dan was suffering from anxiety and depression due to the kind of life he was living. Dan eventually confessed he has been drinking alcohol to relieve stress and overcome suicidal feelings, which has been haunting him constantly. From this perspective, it became evident that Dan suffered from anxiety and depression, which compelled him to commit suicide.
Constructive Reflection on Management and Outcomes
The health care system in the United Stated treats depression and anxiety as mental disorders that require emergency attention when patients seek medical attention. According to Agency for Healthcare Research and Quality (2004), “major depressive disorder is the leading cause of disability among adults, and suicide ranks as the second leading cause of death” among adolescents in the United States who have the ages between 10 to 17 (p. 1).
In this view, depression is an emergency psychiatric condition, which requires appropriate diagnosis and treatment. Given that depression and anxiety are latent mental disorders, the psychiatric emergency unit should have appropriate tools that are necessary to make an accurate diagnosis and effective treatment.
Marchesi, Brusamonti, Borghi, Giannini, Minneo, Quarantelli, and Maggini (2004) recommend psychiatrists to examine social factors as well as other comorbid factors when diagnosing the cause of depression among patients. Comorbid factors usually mask the presence of anxiety and depression, thus complicating their diagnosis and treatment in a psychiatric emergency unit.
The American Psychiatric Association prepares and updates guidelines that are applicable in diagnosis, treatment, and management of mental disorders. Since depression and anxiety are common mental disorders, the American Psychiatric Association has formulated guidelines for their diagnosis, treatment, and management.
In this view, the mental health guidelines require psychiatrists to perform comprehensive diagnosis and treatment of depression and anxiety.
Gelenberg, Freeman, Markowitz, and Rosenbaurn (2010) state that, “patients should receive a thorough diagnostic assessment in order to establish the diagnosis of major depressive disorder, identify other psychiatric or general medical conditions that may require attention, and develop a comprehensive plan for treatment” (p. 15). These guidelines are applicable in a case like that of Dan because he was suffering from anxiety and depression.
My colleagues and I responded well to the case of Dan because we followed the guidelines of the psychiatric emergency unit, which stipulate diagnosis, treatment, and management of mental disorders. The first procedure was to assess the mental disorder of Dan by examining signs and symptoms.
From the physical appearance, Dan looked unhappy, miserable, sad, and frustrated. Such signs and symptoms showed that Dan was suffering from a mental disorder. The second procedure was to differentiate mental disorder and other comorbid factors such as should pain. Rhodes, Kushner, Bisqaier, and Prenoveau (2007) argue that depression and anxiety are latent mental disorders that require critical examination for their diagnosis.
Thus, assessment of the social life of Dan was necessary to establish current and past issues that might have contributed to depression and anxiety. On further inquiry, Dan confessed that drugs and alcohol have helped him overcome depression and suicidal feelings.
Therefore, basing on the assessment, we gave Dan cognitive and behavioural therapy, which aimed at reducing depression, anxiety, alcohol consumption, and drug abuse. We also ensured that Dan received enough social support for him to suppress suicidal feelings.
The emergency intervention that Dan received at the psychiatric emergency unit focused on recovery because it targeted pertinent aspects of therapy for anxiety and depression. Firstly, the diagnosis was recovery-focused procedure because it aimed at identifying the causes of the depression and anxiety. Identification of the causes of anxiety and depression aids in development of appropriate treatment plans (Nelson, Pikalov, Berman, 2008).
Secondly, the separation of the comorbid factors from the mental disorder was a recovery-focused practice because it enhanced accuracy of diagnosis. Since anxiety and depression are hard to diagnose using clinical features, assessment of the mental disorders basing on the current and past social life of a patient focused at enhancing identification of traumatic events and development of a treatment plan.
Since Dan was a prisoner, psychiatrists could have improved the outcome of the therapy by considering social support that he needs to receive from the prison environment. Snowden (2003) argues that psychiatrists need to identify traumatic events that cause anxiety and depression among patients.
Identification of traumatic events enables psychiatrists to provide essential social support and alleviate their traumatic impact on depression and anxiety. In this view, psychiatrists should have improved the outcome of the therapy by ensuring that the criminal justice system provides conditions that alleviate depression and anxiety among prisoners who are at risk of developing post-traumatic stress syndrome.
Mental health plays a central role in determining the general health of an individual. Common mental disorders such as depression, anxiety, psychosis, obsessive-compulsive disorder, social phobia, panic disorder, and post-traumatic stress disorder cause disability among individuals. The case scenario of Dan depicts a patient with anxiety and depression.
Anxiety and depression are common mental disorders that require emergency psychiatric services. At the emergency psychiatric unit, psychiatrists should gain the trust of patients so that they can perform comprehensive diagnosis that encompasses physical, social, and psychological aspects of a person. Moreover, application of appropriate psychotherapy is essential for effective treatment of mental disorders.
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