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Mental Health Assignment: Nursing & Risk Assessment of a Client


Task: Mental Health Assignment Instructions: 1. Consider a client who you have engaged with in your clinical setting and provide a brief on identified case history as well as a comprehensive Mental State Examination and Risk Assessment.

2. Using this client, construct a Case Formulation utilising the 5P formulation model as a guiding framework and refer to your completed mental state examination and risk assessment

3. In constructing this assessment, it is important that you consider and integrate a mental health nursing lens and consider the types of nursing skills that may be required when undertaking assessments and formulating a plan.
Your assessment should include:

  • A summary of your Case Formulation. The summary should explain how sections are inter-related.
  • An analysis on how each section of the Case Formulation was derived. In this section you will need to draw on a completed Mental State Assessment and Risk Assessment, as presented in the appendix.
  • An explanation as to how mental health nursing skills and knowledge would be utilised in all aspects of your Case Formulation.
  • Five “take-home” lessons for the mental health nurse that have become evident while working through this unit of study and completing this assessment.


Summary Of Case Formulation
In this mental health assignment, an individual has been diagnosed by conducting his mental health assessment and risk assessment. For the case formulation and underlying of the patient situation the 5Ps model of mental health assessment has been applied and this mental health, assessment model will help in addressing the major issues that the person has been facing for some time. The client John Riley is a 36-year-old individual who has been facing significant episodes of mania, which was depicted by his high energy levels, strange behaviour and also often becoming aggressive. Using the 5Ps, systematically the presenting problem, predisposing factors, precipitating factors, perpetuating factors with the protective factors has been analysed for the client (Macneil et al., 2012). This includes an assessment of several internal as well as external environmental conditions for the client to understand the various impacts that led to his excessive alcohol use. During the assessment process, the particular individual has been assessed in depth and his issues which have been rooted deep inside his mind have been assessed to help him get diagnosed and improve his mental health situation. During the particular assessment process, he and his parents both were interviewed to understand the patient situation also the troubles being faced by him. These case formulation tools used during the assessment will help assess the past and present reasons of distress and the present mental health condition of the person.

The case formulation is undertaken by applying nursing skills and assessing further associated risks for the individual. This case formulation reveals that the individual has bipolar mania and hence suitable nursing interventions need to be provided accordingly. With the case formulation mental state assessment along with potential risk assessment the examination of the mental health nursing skills and knowledge has been explored also take-home lessons has become evident.

AnalysisOf Section Of Case Formulation
Mental health nurses before providing suitable intervention need to diagnose the patient, while selecting a particular tool. Case formulation using the 5Ps framework revealed that John Riley has been having maniac attacks. It was observed that John Riley has faced several episodes of manic in the last few days as complained by his parents and also the patient himself. The referral letter and video revealed the current situation faced by the patient, which has been further analysed using the case formulation tool the 5Ps.

In the initial stage of the mental health assessment, his background has been scrutinized to gain insights into his daily or regular lifestyle and the issue that are mostly causing distress in his life. It was observed that John Riley is a 36 years old individual who has recently lost his job and has also separated from one of his permanent partners (Dols et al., 2014). His parents who have accompanied him stated that he is experiencing very difficult times and is going through episodes of rage and his mother is even scared that he may destroy the properties out of his rage. (Grey et al., 2018).He has spent all of his money in his relationship and has begun to drink heavily. His parents said that he did not take any medication and that he had similar periods when he was in school, and he was known for his similar kind ofbehaviour.During the assessment, he confronted the doctor that he cannot sleep or eat properly and is facing various issues regarding his regular life. It was also observed that in the present scenario he was referred to as a mad maniac at his workplace and was removed by his boss for similar kinds of behavioural factors. This has led to his distress to a great extent and has caused a lot of mental distress for him and his family as well. He also behaved with his co-workers in a strange manner that was difficult to understand. Moreover, at times he can also hear various noises or voices that are talking to him and thus he is unable to continue with his regular life as all these are causing distress for him regularly (Maddaloni et al., 2018). His parents also reported that he had transitioned from being a social drinker to becoming an alcoholic. Upon being presented in front of the psychiatrist he clarified that he had been referred to by his GP, and had no knowledge why he was there. When confronted with his behavioural outcomes, he did not agree or answer them eagerly rather he spoke fast and became aggressive when asked his name or why he was there. He had started ordering food in the clinic as he stated he was hungry, which is an indication that he did not have much presence of mind. Thus, the presenting problem of the current patient was his behavioural outburst that was becoming difficult to tackle by his elderly parents and back at his job and relationship as well.

The case formulation is based on the 5Ps model and these 5 major factors will help in understanding the current mood of the person and all other related. After the presenting condition, it becomes essential to evaluate the predisposing factors. Predisposing factors include environmental, biological, or personality issues, as well as substance abuse or usage, which may have put the client at risk (Phillips, &Kupfer, 2013). Such events or situations might occur in the past or present, and they can have an impact on one's life to a large extent, and on the individual's current existence. Facts and circumstances such as job loss, the breakdown of a long-term relationship, and heavy use of alcohol are all possible circumstances affecting the client. His relationship status and departing of his long-term girlfriend appears to have had a significant impact on him, leading to his. His moments of madness were more obvious once he returned to live with his parents. It is apparent that the transition from living with his lover for long periods to living with his parents had an impact on him and generated an emotional eruption in the form of bipolar mania (Waszkiewicz et al., 2012). He was unable to deal with difficulties at work, and as a result, he lost his job.

In the next stage of the case formulation that is the precipitating factors are mostly internal and external events that have a significant impact on an individual's life and cause a problem for the individual, leading to substance abuse and further troubles has been identified (Glass, &Contrada, 2012).John Riley's biggest concern in the present circumstance was his lost relationship, and the fact that he has been separated from his permanent life partner emerged as the main cause that is impacting his mental health. Due to his behaviour, he is seen to be socially isolated, without friends or anyone to share his feelings, hence he refers to going up to the Pope in the church for sharing his feelings. His delusional method that he is searching for a cure for cancer by hearing some upper-level voice and indication from God depicts his lack of connection to reality (Palmier?Claus et al., 2020).He has lost control of his mind completely and his ability to focus. Functional impairment in him was absent rather he was seen to be possessing high levels of energy and being very confident about his current state.

The sustaining factors are those that determine whether or not people will continue to use substances, resulting in misuse problems. Understanding this particular element will aid in comprehending the individual's present behavioural development and how much grief he felt so that he can avoid similar situations in the future henceforth. In the current circumstances, the main sustaining variables determining John Riley's mental health are any form of dialogue or recollection related to his long-term partner who has abandoned him (Barbosa et al., 2012). As a result, he will be more distressed in his life and will be unable to deal with life's daily obstacles. While he had a similar episode of bipolar mania at school, he was not treated and the condition was eventually expelled. His parents assumed he had healed on his own. The client could not get any rest or eat regular, resulting in an attention deficit, which causes them to hear voices and appear delusional (Hänsel et al., 2015). His ideas appeared to be racing in his head, and the mental health practitioner in the interview had to keep up with him since he was speaking quickly and displaying unusual behaviour such as order a meal at the clinic. The perpetuating factors that are enforcing the client’s current substance use include his relationship status, social status and also mental condition along with thought process.

Identifying variables that tend to create and support a person's emotional health, allowing the individual to moderate, are the protective factors and can emerge crucial in planning for suitable nursing interventions. These particular criteria are selected to assist the person in identifying his strengths and to contribute significantly to the development of a support system that aids in the person's mental health (Håman et al., 2017). Spending more time and engaging in activities that tend to improve his mental health will aid him to come out of his predicament. Though these factors often remain underutilised, however, these need to form the basis for nursing intervention for this present client situation.

ExplanationOf Mental Health Nursing Skills
Mental health nurses are expected to develop knowledge and skills so that they can diagnose patient conditions also provide necessary interventions. Nursing skills and knowledge forms the basis for patient treatment and recovery. Hence nursing in their patient care needs to undertake the use of evidence-based practice such that they can provide appropriate patient care and reduce resilience amongst mental health patients (Goossens et al., 2020).

While the domain of mental health nursing has transformed immensely in the past decades with a reduction in usage of psychotic drugs, it is expected that patients are treated with compassion. As diagnosed in this case, the patient experiences mania as phases of bipolar disorder, there are tremendously high and low emotional cycles. As in type I bipolar disorder as experienced in the current patient case, his mood appears abnormally heightened, special care needs to be undertaken for explaining the situation to him and making him agreed to the treatment (Wickham et al., 2014). Nursing skills and knowledge used in the current case formulation includes knowledge of the assessment tool along with knowledge of the different psychological outcomes with their symptoms (Lally, & McDonald, 2013). This allows classification of client cases also providing appropriate assistance to the client such that they can deal with their situation.

To conclude, it is evident herein mental health assignment that the nursing practices and case formulation skills enable nurses to identify various issues and help the individuals to identify critical mental health assessment problems, which is one of the crucial learning from this case. For instance, in the case of John Riley, it was found out that he was facing various mental health conditions and that was affecting his life to a great extent. He was so much affected that even his parents were affected by his behavioural pattern and therefore they decided to get him diagnosed. Learning from this case formulation includes the application of the 5Ps case formulation that has helped in identifying the deeply rooted issues that were affecting his mental health to a great extent. Hence knowledge of different psychological tools needs to form the basis of nursing practice in the mental health scenario. Thirdly, knowledge of different psychological disorders is necessary for arriving at an appropriate diagnosis. Also, evidence-based practice will allow nurses to undertake a more ethical and practical approach in diagnosing patients. Lastly, nurses need to adopt the compassionate approach in mental health practice to enable them in more comprehensive planning and treatment of patients.

Barbosa, I. G., Rocha, N. P., Huguet, R. B., Ferreira, R. A., Salgado, J. V., Carvalho, L. A., ... &Teixeira, A. L. (2012).

Executive dysfunction in euthymic bipolar disorder patients and its association with plasma biomarkers. Journal of affective disorders, 137(1-3), 151-155.

Dols, A., Kupka, R. W., van Lammeren, A., Beekman, A. T., Sajatovic, M., &Stek, M. L. (2014). The prevalence of late?life mania: a review. Bipolar disorders, 16(2), 113-118.

Glass, D. C., &Contrada, R. J. (2012). Bipolar disorder, Type A behaviour and coronary disease. Health Psychology Review, 6(2), 180-196.

Goossens, P. J., de VeldeHarsenhorst, R., van Lankeren, J. E., Testerink, A. E., &Daggenvoorde, T. H. (2020). Nursing Care for Patients With Acute Mania: Exploring

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Grey, I., Mesbur, M., Lydon, H., Healy, O., & Thomas, J. (2018).An evaluation of positive behavioural support for children with challenging behaviour in community settings.Mental health assignment Journal of Intellectual Disabilities, 22(4), 394-411.

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Hänsel, K., Wilde, N., Haddadi, H., &Alomainy, A. (2015, December).Challenges with current wearable technology in monitoring health data and providing positive behavioural support.In Proceedings of the 5th EAI International Conference on Wireless Mobile Communication and Healthcare (pp. 158-161).

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Macneil, C.A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice.BMC Med, 10(1).doi: 10.1186/1741-7015-10-111

Maddaloni, G., Migliarini, S., Napolitano, F., Giorgi, A., Nazzi, S., Biasci, D., ...&Pasqualetti, M. (2018). Serotonin depletion causes valproate-responsive manic-like condition and increased hippocampal neuroplasticity that are reversed by stress. Scientific reports, 8(1), 1-14.

Palmier?Claus, J., Wright, K., Mansell, W., Bowe, S., Lobban, F., Tyler, E., ...& Jones, S. (2020). A guide to behavioural experiments in bipolar disorder. Clinical psychology & psychotherapy, 27(2), 159-167.

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Mental State Examination and Risk Assessment

5Ps Factors

Presenting Problems

Risk Factors

Risk Rating

Presenting Problem

1.      Increased energy

2.      Feeling Excitement

3.      Not eating

4.      Not sleeping

5.      Impulsive behaviour

6.      Strange behaviour

1.      Easily getting angry

2.      Breaking things

3.      Abusive

4.      Harming people



Predisposing Factors

1.      Excessive alcohol use

2.      History of maniac episodes

3.      Job loss

4.      End of relationship 


Precipitating Factors

1.      Inability to establish relation

2.      Inability to get job

3.      Absence of social circle


Perpetuating Factors

1.      Inability to establish relation

2.      Inability to get job

3.      Absence of social circle


Protective Factors

1.      Parents as support system



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