Case Study Questions


Jolanna is a 20-year-old African American woman who has come to see you at the community mental health center following a visit to the psychiatric emergency room (ER). She presented at the ER saying that she was hearing voices and needed to get back on her medication right away. She was evaluated and treated with a prescription for Geodon and given a follow-up appointment with you. Her presenting diagnosis is major depressive disorder with psychotic features.

Jolanna is the mother of two young children, ages 4 months and 3 years, and lives alone in an apartment with support from a Section 8 voucher. She started taking courses at the community college 9 months ago and has a part-time job at McDonald’s. Jolanna aged out of the foster care system at age 18 and was supported by a caseworker and transitional living program until the time she officially left the system. She currently reports some support from an aunt who visits and gives her money occasionally and from her boyfriend, Zeus, who is the father of her youngest child. She reports that he can sometimes get violent and he does not like her taking medications or getting counseling. She recently tried to reconnect with her mother but found that her mother was consumed with a substance use addiction and did not want to spend time with Jolanna or get to know her grandkids.

Jolanna tells you that she has had a long history of problems with depression starting at age 10, when she was removed from her mother’s home after being sexually abused by her mom’s boyfriend. She stated that she had been “passed around” by her mother for years and had faced things that she “just doesn’t want to talk about.” She says that her first episode of depression began after she was taken from her mother’s home and placed in foster care.

She reported withdrawing from everyone and just crying in her room for weeks. She also reported episodes of rage during which she would become aggressive and throw things around the house and scream uncontrollably. Because of these problems, she had trouble maintaining a stable placement. She was in and out of residential treatment and foster homes and had seven placements during the time she was in foster care. While in foster care, she consistently took medications for depression and aggression, but she stopped taking the medications within a month after leaving state custody. She says that she wanted to see what she was like off of medication and that she didn’t have time, between school, work, and her kids, to get to a psychiatrist appointment. She did well for a while and felt that she was managing all right without the treatment until she had her last baby 4 months ago. The baby does not sleep much and has a medical condition that requires her to make frequent visits to the pediatrician.

Jolanna began having trouble getting out of bed and felt she wasn’t caring for either of her children well. She began thinking about trying to get back on medication, but she didn’t know whom to call. When she began hearing voices telling her to kill herself, she called her aunt and asked her to take the kids so she could go to the ER. In addition to getting on the medications, Jolanna is hoping that counseling can help her to get over her past. She thinks her anger and depression are probably caused by the hard life she has had. She says that she knows that it’s time to do something about this because she wants to be a better mother and give her kids a better life than she had.


  1. What barriers can you identify that may need to be addressed in getting Jolanna engaged into treatment?
  2. What might you do to encourage Jolanna to come back and see you again?
  3. What problems would you like to address with Jolanna while she is seeing you?
  4. What type of treatment might you consider for Jolanna given the evidence presented in this chapter?
  5. What are some of the challenges Jolanna faces that are specific to her transition into young adulthood?