Challenging presentation and mental health nursing    

Care analysis of a service user experiencing acute and challenging mental health problems:
Demonstrate a biopsychosocial understanding of a service users experience and an evidence based approach to your suggested intervention. The service user should have complex needs, which can offer challenges to services. An example of this might be:
A service user who is admitted informally to an acute in patient unit where the doors are locked. The service user may be presenting with depression, alcohol withdrawal and ideas of self-harm.
Care analysis should identify:
– Service users presenting problems, from the biopsychosocial perspective
– Risk assessment and management
– Recovery principles and engagement processes
– Legal and ethical dimensions, such as deprivation of liberty
– Role and responsibilities of the mental health nurse

The client history and presentation should be put in as an appendix
Module aims:
–  Identify and explore the biological, psychological, social and cultural factors that impact on mental health
–  Enable the student to demonstrate expertise in eliciting a full biological, psychological and social history and to critically examine the links between causation, symptomology, treatment and management of challenging mental health presentations
–  Facilitate the exploration of the experience of acute and challenging presentations and critically analyse knowledge and experience to make clinical judgments
Demonstrate competence in the use of care planning to promote service user independence and recovery
Knowledge and Understanding
–  Understand the biological explanations of mental health problems addressed with psychological and social perspectives of human responses and behaviour
–  Evaluate data to identify and define acute / challenging presentations, analyse the use of specific nursing interventions and, informed by best available evidence, utilise a collaborative approach when formulating and evaluating assessment and interventions used

Intellectual Skills
–  Analyse the legislative frameworks, ethical dimensions and policy context in relation to complex mental health presentations
–  Analyse and apply a variety of assessment tools and frameworks in relation to challenging mental health needs and presentations
–  Analyse and apply research to clinical practice

Document Layout:
–  Front page including your student number and word count
–  Double line spacing
–  Size 12 font
–  A margin of at least 2.54 cm on all sides of A4 paper
–  Candidate number as header on all pages
–  Page number as footer on all pages

Personality Disorder
–  A bio-psycho social perspective on personality development
–  Understanding of diagnostic criteria for personality disorder
–  Engaging with the service user
–  Assessing risk, including the risk of self-harm, attempted suicide and risk to others
–  Legal and ethical frameworks for care
–  Nursing intervention and the use of ‘self’ in engaging with this client group
–  Development and documentation of care plans to achieve optimal health, habitation and rehabilitation, based on assessment and current nursing knowledge

Risk Management
–  Understanding risk – the use of positive risk taking
–  Collaborative approaches to risk management – clinical decision making
–  Selection and application of appropriate assessment tools
–  Promoting the use of nurturing, psychologically and environmentally safe environments
–  Prioritisation of need
–  Empowering service users – maximising choice and decision making wherever possible
–  Developing communication skills, written and verbal
–  Legal and ethical frameworks for care

Dual Diagnosis
–  Selection and application of appropriate risk assessment tools and specific techniques in assessing substance misuse and co existing mental health problems
–  Assessment of physical health needs in relation to substance use
–  Collaborative approaches to care and care planning
–  Understanding the impact of specific substances on the service users physical and mental well-being (during use and detoxification regimes)
–  Promoting service user understanding and ownership of care and treatment
–  Legal and ethical frameworks for care

Core Reading List
Barber, P. and Brown, R.E. (2012) Mental health law in England and Wales, 2nd ed. London: Sage Publishing.
Bartlett, P. and Sandland, R. (2014) Mental health law: policy and practice, 4th Edn. Oxford University Press.
Bennett, P. (2011) Abnormal and clinical psychology: an introductory textbook, 3rd Edn. Maidenhead: Open University Press.
Burke, T. (2010) ‘Psychiatric disorder: frequency and mechanisms in understanding violence’ in Forensic mental health: concepts, systems and practice, Bartlett, A. McGauley, G. (eds). Oxford: Oxford University Press.
Crome, I., Chambers, P., Frisher M., Bloor R. and Roberts, D (2009) Research Briefing: The relationship between dual diagnosis: substance misuse and dealing with mental health issues. Available from riefing30.pdf (accessed 18/12/15).
NICE (2010) NICE guideline – psychosis with coexisting substance misuse. The British Psychological Society and The Royal College of Psychiatrists. Avalibale from: guideline-181586413 (acc3essed 18/12/15).
Hart, C. (2014) A pocket guide to risk assessment and management in mental health, Oxon: Routledge
National Institute for Mental Health in England (NIHME) (2009). Personality disorder: No longer a diagnosis of exclusion: London: NIHME.
Steen, M. & Thomas, M. (2015) Mental health across the lifespan. Oxon: Routledge.
Optional Reading
Alexander, R., Devapriam, J., Michael, D., McCarthy, J., Chester, V., Rai, R., Naseem, A. and Roy, A. (2015) “Why can’t they be in the community?” A policy and practice analysis of transforming care for offenders with intellectual disability, Advances in Mental Health and Intellectual Disabilities, 9 (3), pp. 139-148.
American Psychiatric Association. (2013) The diagnostic and statistical manual of mental disorders (DSM) V. 4th ed. Washington DC: American Psychiatric Association.
Bouras, N., Hardy, S. and Holt, G. (2013). Mental health in intellectual disabilities. London: Pavilion Press.
Department of Health. (2014) Achieving better access to mental health services by 2020. In: Department of Health: London.
Gates, B. and Mafuba, K. (2015) Learning disability nursing: Modern day practice. London: CRC Press, Taylor & Francis.
Cambridge, P. (2013) A rights approach to supporting the sexual fetish of a man with learning disability: Method, process and applied learning, British Journal of Learning Disabilities, 41 (4), pp. 259-265.
Clark, A., Browne, S., Boardman, L., Hewitt, L. and Light, S. (2014) Implementing UK autism policy & national institute for health and care excellence guidance- assessing the impact of autism training for frontline staff in community learning disabilities teams, British Journal of Learning Disabilities, (early view).
Fish, R., Woodward, S. and Duperouzel, H. (2012) ‘Change can only be a good thing:’ staff views on the introduction of a harm minimisation policy in a forensic learning disability service, British Journal of Learning Disabilities, 40 (1), pp. 37-45.
Flynn, M. and Citarella, V. (2013) Winterbourne view hospital: A glimpse of the legacy, The Journal of Adult Protection, 15 (4), pp. 173-181.
Inchley-Mort, S., Rantell, K., Wahlich, C. and Hassiotis, A. (2014) Complex behaviour service: Enhanced model for challenging behaviour, Advances in Mental Health and Intellectual Disabilities, 8 (4), pp. 219.
James, I.A. (2011) Understanding behaviour in dementia that challenges: a guide to assessment and treatment, (Bradford Dementia Group Good Practice Guidelines), London: Jessica Kingsley Publishing
Jones, R. (2014) The story of baby P: Setting the record straight. University of Bristol: Policy Press.
Loshak, R. (2013) Out of the mainstream: helping the children of parents with a mental illness: New York, Routledge Press.
McCann, E. (2015) People who are transgender: Mental health concerns, Journal of Psychiatric and Mental Health Nursing, 22 (1), pp. 76-81.
Whittington, R. Logan, C. (eds) (2011) Self harm and violence: towards best practice in managing risk in mental health services, Chichester, Wiley-Blackwell
Optional Materials
– Challenging behaviour foundation –
– The International Journal of Positive Behavioural Support –

Interesting editorial: Use of medication for challenging behaviour in people with intellectual disability; Gyles Glover, Sarah Bernard, David Branford, Anthony Holland, Andre Strydom; The British Journal of Psychiatry Jul 2014, 205 (1) 6-7; DOI: 10.1192/bjp.bp.113.141267 –
From NHS England:
–  Building the right support (also available in easy read), a national plan to develop community services and close inpatient facilities for people with learning disabilities and/or autism who display behaviour that challenges, including those with a mental health condition.
–  The Service Model (also available in easy read) (and supplementary information) for commissioners, that describes what good services should look like.
Alongside this, NHS England has also published:
–  Final Care and Treatment Review (CTRs) guidance and tools (also available in easy read) to support commissioners in preventing unnecessary in-patient admissions and lengthy hospital stays.
Department of Health (2014) Care and Support Statutory Guidance. Available from attachment_data/file/366104/43380_23902777_Care_Act_B ook.pdf (accessed 18/12/15).
Skills for Care Positive behaviour support ehaviour-challenges/Positive-behaviour-support.aspx (accessed 18/12/15).
Skills for Care People whose behaviour challenges ehaviour-challenges/People-whose-behaviour-challenges .aspx (accessed 18/12/15). ildren…/working-together-safeguard -children-guidance- 2013.aspx…/working-together-to-safeguard- children 

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