Case Study: Bipolar disorder

Mary is a 40-year-old teacher who has bipolar disorder and she has just been referred by her General Practitioner to the Crisis Resolution Home Treatment Team.  She has recently relocated with her partner’s job to a different part of the country and has lost regular contact with her wide circle of friends and her family. Mary has not slept well over the last 2 weeks and is feeling agitated and increasingly irritable. Her partner is very concerned about her and she is angry that she is meeting the mental health practitioner. 

To manage Mary’s current frustration and ambiguity about the value of any potential input the mental health practitioner needs to ensure that a shared understanding of potential benefit can be reached. The main priority is improving Mary’s mental health and functioning alongside a recovery-focused approach. The mental health practitioner therefore needs to ensure that during the assessment process the central themes underpinning the approach are: collaboration, involvement of partner, managing distress, identifying strengths and building on existing coping strategies. These themes will underpin working towards improved mental health and functioning and Mary’s ongoing self-management.

Theoretically, when beginning the assessment process with Mary it can be difficult for the nurse to manage large amounts of information and to establish a systematic approach to increasing understanding of the current and ongoing issues that are faced by Mary. It is this process of gathering together information that will underpin your clinical decisions and will be used to plan interventions. By starting with a broad based assessment process and then clarifying areas that warrant further consideration,  either/or symptoms and needs, using a range of specifically focused assessment tools can help to determine the most appropriate course of action. 

Using a systematic approach to assessment with Mary enables the nurse and Mary to develop a collaborative relationship. Working together and using a systematic approach to the assessment process can help both Mary and the nurse to make sense of the situation. It is an essential part of the care process and should inform decision making. For Mary and the nurse the assessment process is central to understanding experiences and building on strengths and an essential component in developing meaningful outcomes against which to measure recovery, self-management and treatment alike.