Risk Management- Psychiatry

Risk Management- Psychiatry

Risks in psychiatric care refer to the likelihood or imminence of any adverse events occurring during the process of care. Violence, self-harm and self-neglect have been reported during care processes for patients presenting with mental illnesses. Accordingly, an appropriate response is usually warranted for these risks. An established risk assessment framework should be put in mental health care centers to address these presenting illnesses rapidly. Suicides, for instance, have increasingly been reported among psychiatric patients undergoing mental health care. Research findings reveal that up to 25% of mental health patients receiving psychiatric care succumb to suicide yearly. Guidelines recommend using risk assessment tools during the patient management process and not as predictors of risks such as suicides. Accordingly, this paper details fictional incidents of risks in mental health care, emphasizing their presentation and the precipitating factors of these risks.

Scenario One: Kevin Peterson

The first incident is of a young man aged 35 from Akron named Kevin Peterson. This man was reported to have attempted suicide by jumping from a 7th-floor balcony at 8 pm in one of the neighborhoods in Akron. Witnesses narrate that they found him writhing in pain after this botched attempt before calling the police. CCTV footage from the building showed the last incidences before the man jumped off his balcony. In the video, Kevin is seen writing and dropping a note on his balcony floor. He then recites what looks like a prayer before jumping head first. Kevin, however, hits a post on the third floor of the residential apartment, sending him spinning from left to right. He lands on the ground, knee first, sustaining serious injuries to his limbs, abdomen, and spine. Kevin was found by the neighbors, who heard a crashing sound on the ground.

The medical history of the patient was significant, with multiple suicide attempts. In one incident, he had taken an overdose of paracetamol but was rescued and hospitalized. He threw himself in front of a racing car on a highway in Cleveland in another attempt. In this second instance, he miraculously survived, escaping with only minor injuries after the car driver missed him slightly by swerving to the right. Unfortunately, the car overturned and collided with another vehicle in a separate lane. Three fatalities were reported from the incident. During this last instance, he is said to have escaped from a community rehabilitation center where he had been held since the accident in Cleveland.

In all three incidences, this man left handwritten notes documenting his motives. In the first instance, he is said to have written a letter to his parents, blaming them for his poor upbringing. He narrates that his parents never cared enough for him and that he attributes his suffering to them. He finishes the note by saying goodbye to his grandmother, whom he cherishes. In the second note, he says that he has decided to die by the road and that if found missing, the search team should head to Cleveland. He finishes the note by noting, “death by road is not bad after all.” In this note, he sends a congratulatory message to his sister, who has just graduated from college with a degree in medicine. In the third note, which represents the current case, he notes that that was his third attempt at dying. On this note, he seems to be angered by the death of his grandmother. Also, he seems to have reconciled his bitterness with her parents, even noting that “I know you have tried to be good to me. It is my time now to go”.

Further exploration into this man’s case reveals that he is the last born in a family of six. All his other four siblings (one girl and two boys) are alive. Both of his parents are also alive and live in Cleveland. He is a college graduate with a bachelor’s in art and has been working at a local studio in Cleveland until four years after the incident when he moved to Akron. His family history is negative for any chronic disease and even depressive disorders. Kevin, however, has a significant history of drugs and substance abuse. During the clinic visit that confirmed his positive diagnosis of major depression, he reported having used cannabis since his 18^th birthday. He is also a heavy alcohol drinker and occasionally uses other illicit substances.

Collaborative history from the family revealed that Kevin had been a troubled man having mental health issues for a considerable time. His medical history was positive for major depressive disorder since his 26th birthday. He has since been taking antidepressant medications. He seemed to have a good prognosis for his disease until he relocated to Akron from Cleveland. Since then, his condition has deteriorated, costing him his job. He is also reported not to have gone for a refill for his antidepressant medications.

This client has a positive diagnosis of major depressive disorder. The suicidal attempts seen in this client’s case are attributable to his disease. Depression is one of the leading causes of functional disabilities, morbidity, and mortality among patients presenting with mental illnesses. Comorbidity with alcohol and substance abuse disorders often exacerbates the symptomatic presentation of these disorders and has been implicated in significant morbidity and mortality in these groups of patients (Peterson, 2022). Depression is also a leading cause of suicidal ideation and tendencies. In the case presented, Kevin Peterson has had multiple attempts at taking his own life. The suicidal tendencies seen in this individual may be attributable to his disease, not taking medication appropriately, and comorbidity with alcohol and substance abuse disorders (Orsolini et al., 2020). In this case, aggressive treatment with psychotherapy and antidepressant medication may relieve his suffering.

Scenario Two: Andrew Sean

A second incidence involves a 32-year-old Caucasian male from Brooklyn, NY. This man named Andrew Sean, is reported to have been involved in a series of violent crimes within his neighborhood. In this instance, reported on Tuesday afternoon, Andrew is said to have been involved in at least five violent crimes. In the first crime, he is captured in a CCTV camera brutally beating a man on a bicycle before fleeing with his bicycle. The man sustained serious injuries, including a broken rib, but luckily survived. Thirty minutes later, he is seen running away from a local store with his handbag stashed with foodstuff. The store owner reported this matter to the police via the police hotline. In the third instance, the man is said to have been involved in a street fight in a nearby neighborhood, injuring two people. Andrew, however, sustained minor injuries on his chest and abdominal areas. In the fourth instance, Andrew is seen in the company of two other unidentified persons robbing a lady of her phone and cash. Witnesses report this matter to the police. This man is arrested after a police search, pointing a knife at an old lady at a metro bus station.

Exploration into the man’s history reveals a significant history of arrests and crimes. The police note that he has become a notorious figure in Brooklyn’s crime arena, always terrorizing his neighborhoods. Additionally, he is living a disgruntled life with little signs of appropriateness in self-care and regard for self. The police noted that this individual “looked terrible,” with evidence of bloodstains on his garments, unkempt hair, unpleasant odor, and smelly feet. He was, however, articulate in his speech. When asked why he was doing all that, he responded with a small grin and said, “for fun.”

This man is the firstborn in a family of four. His younger brother is a teacher. His parents are still alive and live in Manhattan. He is a former teacher who was fired after beating up one of the students. He has since been living in Brooklyn in a house bought for him by his parents. His family history is significant of bipolar disorder, with his mother and paternal grandfather having been diagnosed with the condition. He has had previous cases of crime. The majority of these cases occur when he is under the influence of alcohol. His history is significant of alcohol and substance abuse. Collaborative history from the parents reveals that he has always been a charismatic, caring, and loving character when under medication. However, he changes to assume a wild character, always shouting at people, easily irritated and tends to hit people whenever irritated.

Medical and medication history reveals that Mr. Andrew is known as bipolar and was diagnosed with this disorder eight years ago. Nonetheless, he has not been compliant with his medications. His parents claim that he misses the medications intentionally because the medications make him feel bad. Bipolar disease is a complex mental disorder characterized by depressive, manic, and hypomanic phases. The depressive phase presents symptoms similar to those seen in major depressive disorder, with the patient being withdrawn, purposeless, and sad. The manic phase is characterized by irritability, distractibility, and delusions. This disorder has a propensity for genetic predilection. The symptomatic presentation of bipolar disorder is often varied, with extreme swings in the mood apparent.

Mental health disorders have been implicated in violent crimes. Bipolar disorder, for instance, has been implicated in up to 10% of violent crimes reported (Peterson, 2022). In the case above, Andrew’s behavior can be attributed to his disease. As seen in this individual, comorbidities with substance abuse have been implicated in increased crime rates among persons presenting with this disorder (Fovet et al., 2018). Aggressive medication with mood stabilizers and antidepressant medication may be necessary for this individual. Additionally, Andrew should be taken to rehabilitative centers for behavioral rehabilitation. If found guilty, he should be dealt with per the law.

Scenario Three: A Private Health Facility in Alaska

The third incidence is a private health facility licensed to offer psychiatric care in the remote areas of Alaska. This hospital was established by a non-governmental organization upon the realization that the residents of Alaska had limited access to mental healthcare due to its geographical location. This establishment was also informed by the growing number of Alaskans presenting with mental illnesses. The hospital saw an exponential rise in patient attendance and even began institutionalized care. For many months, this institution was lauded for its excellence in care provision. This would take a turn after a change in the administration.

The new administration gave little regard to this hospital’s quality of care provision. The hospital soon ran out of medical supplies and essential diagnostic and treatment tools. Healthcare professionals became discouraged by these poor working conditions and began leaving. As it stands, the hospital has inadequate personnel to handle patients presenting with mental illnesses. Additionally, the hospital lacks important health resources utilized in psychiatric care, such as medicines and diagnostic, and treatment equipment. With the growth in the patient population being realized, the hospital bed capacity is overstretched, with patients sometimes having to spend in makeshift beds.

In this case, several psychiatric risks are apparent. These risks jeopardize mental health care in this healthcare facility and may be attributable to poor patient outcomes and consequent suffering. The first risk is the inadequate healthcare professionals to handle patients presenting with mental illnesses. Inadequate healthcare professionals have remained an issue in mental healthcare for a considerable time. The impact of this problem is often evident in higher provider-to-patient ratios, with consequences being a higher work burden on the available staff and poor-quality care provision due to the decreased time of contact between the caregiver and patients. Lack of specialty care is also an issue and has been implicated in misdiagnosis, ineffective treatment, and poor patient outcomes.

Inadequate diagnostic and treatment equipment is also another health hazard in psychiatry. The prognosis of mental health illnesses is dependent on early detection of the disorders and early initiation of treatment. In the absence of diagnostic and treatment equipment, healthcare professionals cannot timely diagnose these disorders and offer effective treatment. This problem is even compounded in the absence of essential medications required to treat these disorders, as seen in the presented case. In this case, the healthcare providers cannot offer solutions to the problems the patients are presenting with (Cuomo et al., 2020). The overall effect is usually felt by the patients who live with untreated or undiagnosed diseases. The long-term consequences are often dire, with significant morbidities and mortalities being apparent.

Hospitals remain sources of healthcare facility-related psychiatric risks. Such risks as those highlighted in the case provided risks to both the patients and the caregivers. Such hospitals undermine the efforts placed by the government to ensure access to quality care for all mentally ill patients. To correct this, the hospital must ensure effective management of the psychiatric clinic. The hospital should also enable functional expansion to include more staff, better diagnostic and treatment equipment, and inpatient capacity expansion to accommodate the increasing numbers of psychiatric patients.

Conclusion

Several incidents often present in psychiatric clinics and within communities that pose risks to psychiatric patients and the general public. These risks may either harm the patients or the healthcare providers. Violence, crimes, and self-harm are common presentations reported frequently within communities whose perpetrators are persons with mental health illnesses. In all cases, rapid address of the problem remains critical in preserving the lives of those individuals and of the community members who could be affected negatively by their actions. The establishment of a framework to assess and combat these risks remains important. These frameworks will ensure that these risks are addressed before negative impacts attributable to these individuals’ behavior are experienced. Healthcare providers and governments play a crucial role in ensuring that these problems are effectively managed within the community.

References

Cuomo, A., Koukouna, D., Macchiarini, L., & Fagiolini, A. (2020). Patient Safety and Risk Management in Mental Health. Textbook of Patient Safety and Clinical Risk Management, 287-298. https://doi.org/10.1007/978-3-030-59403-9_20

Fovet, T., Geoffroy, P., Vaiva, G., Adins, C., Thomas, P., & Amad, A. (2015). Individuals with Bipolar Disorder and Their Relationship with the Criminal Justice System: A Critical Review. Psychiatric Services, 66(4), 348-353. https://doi.org/10.1176/appi.ps.201400104

Orsolini, L., Latini, R., Pompili, M., Serafini, G., Volpe, U., & Vellante, F. et al. (2020). Understanding the Complex of Suicide in Depression: from Research to Clinics. Psychiatry Investigation, 17(3), 207-221. https://doi.org/10.30773/pi.2019.0171

Peterson, J. (2022). Mental illness is not usually linked to crime, research finds. https://www.apa.org. Retrieved 16 May 2022, from https://www.apa.org/news/press/releases/2014/04/mental-illness-crime.

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We saw that risk management involves playing the devil’s advocate and asking, “What could go wrong?” Creating scenarios and thinking through situations will help you understand the nature of the risk better. This is your exercise for the week.

Risk Management- Psychiatry

Create three fictional incidents for the risk area you selected in Week 1. Write about each scenario in not more than 2 pages. Include the following information about each scenario:

Details of the incident—What, where, when, and who?
Explain the cause—How and why?
Include an introduction, conclusion and reference page to this assignment.

To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Submission Detail:
Your assignment should be addressed in an 8- to 10-page document.
Submit your documents to the Submissions Area by the due date assigned.