Case study: Post-traumatic stress disorder

Jose went to see his GP because he was getting in trouble at work.  He had started arguing more with colleagues, and his foreman had noticed that he was isolating himself a lot of the time.  He pulled Jose to one side and told him to buck his ideas up or get out. 

Jose told his GP that he felt a sudden rage inside himself sometimes and that he couldn’t control it.  He had felt it since his last tour in Afghanistan as an infantryman.  His GP referred him to the mental health nurse attached to the practice, and Jose attended for a first appointment.

The mental health nurse encouraged Jose to describe his experiences on active duty, and also explored other situations where Jose’s ‘rage’ emerged.  He described feelings of sudden anger when driving, in the supermarket, and at work. He viewed these as uncontrollable and unpreventable as he never knew when it would happen.

The mental health nurse recognised some signs of post-traumatic stress, and with Jose’s permission, emailed the Military Veterans Service and Help for Heroes to arrange for them to offer specialist help.  There was going to be a delay while an assessment was arranged, so the mental health nurse arranged to see Jose fortnightly for support.

Over the next few meetings the mental health nurse taught Jose some self-soothing and relaxation techniques involving deep breathing and visualisation.  Jose was encouraged to use these techniques daily to lower his residual stress levels.  They also worked on a daily activity plan which involved Jose eating more healthily and regularly, increasing his daily exercise, and reducing his alcohol intake. They also spent some time considering what Jose’s girlfriend might notice in him, that would tell her that he was managing things better. Those things were then built into the treatment plan as milestones to work towards.

It took 8 weeks for the Veterans services to visit Jose, and they accepted his referral and will be offering him cognitive behavioural therapy.  They were pleased with the work that had been done by the mental health nurse, as Jose now felt that some aspects of his behaviour were more under his control.  Jose’s care was then taken over by the Military Veterans Service and Help for Heroes, and the mental health nurse discharged Jose.