Research Proposal on "Assessing a Person for Mental Illness"

Research Proposal 7 pages (2507 words) Sources: 5 Style: APA

[EXCERPT] . . . .

professionals who are trained in the identification and treatment of clients with mental illness. 2. Identify and discuss all the key elements in assessing a person for mental illness, i.e., what factors MUST be considered by staff? 3. (a) Identify and discuss the critical areas to assess in a suicidal person. (b) Specifically address the issues of safety and self-harm. (c)Discuss risk factors and differences such as age groups, gender, culture, and religion. 4. (a) Discuss how confidentiality plays into all of this. (b) Include one or two paragraphs about the "new" HIPAA (Health Insurance Portability and Accountability Act) standards. (c) Then answer the following: How will HIPAA affect mental health providers and consumers? (You will need to be creative with this question and "think outside of the box")."

Seeking Aid, Offering Help

Millions of Americans are affected either directly or indirectly by mental disorders, either struggling with a range of symptoms themselves are trying to help a loved one get the kind of help that they want and even need. Many people who are struggling to overcome the barriers that mental disorders place in their lives simply live with their disabilities for years, even decades, in part because they may not know how much help is available for them and in part because of the enduring stigma that is attached to mental disorders. Finally many people will be driven to seek out professionals to provide the kind of accurate diagnoses that will help them get the treatment that they need. If it is a person's first time attempting to get professional help she or he may not exactly know whom to go to -- a psychiatrist? A psychologist? A therapist? A social worker? Or just the family doctor? Each of these professionals has training that will allow him or her to assess mental illness in a patient or client -- although given their respective training and the biases that exist in each profession the diagnosis and follow-up treatment will differ (Hood & Johnson, 2006, p. 81). In this paper I will assess the ways in which three different types of professionals diagnose those with mental disorders, comparing and contrasting the ways in which these three types of professionals vary in their approaches to diagnosis and treatment.

Key Elements of Diagnosis

Before detailing the ways in which different professionals address the process of diagnosis and treatment planning, I would first like to summarize the key issues involved in patient assessment because, in large measure, these are the same for the range of professionals who work with the mentally ill.

The first aspect of assessment is that of the patient's safety. Assessing a person for suicidal tendencies -- or outright plans -- is an important part of the intake (or initial assessment) that a mental health professional will perform. This is a part of the assessment even if the patient or client does not make any overt reference to feelings of suicidality. Often a person may be too ashamed to admit that she or he is considering suicide, or the person may be in denial about it. Sometimes they may in effect need "permission" from a professional to talk about their feelings.

Because of the difficulty that many if not most people have in talking about suicidal feelings as well as the range of suicidal feelings, it is important for a clinician to determine both the specificity of the suicidal feelings and their depth. All of us have some feelings of suicidality sometimes although for many of us (and indeed probably most of us) such feelings are mild and diffuse. Most of us have woken up one or two mornings to face a very difficult day and thought "I'd rather due than face today." But then we get up and take a shower and go off to face the midterm/medical test/presentation at work. This is not a degree of suicidality that a clinician (or an individual) needs to worry about.

What a clinician assessing a patient or client for suicidality is concerned with is primarily the specificity of plans. A clinician would want to ask a patient: Do you have a particular plan in mind? Do you have the means to carry out this plan? Do you have a time frame that you are considering? Have you taken active steps to carry out this plan? If the patient or client answers that she has a specific plan, this is something that the clinician needs to take very seriously, but not nearly as seriously as if the client or patient has a specific plan and the means with which to carry it out ( Hood & Johnson, 2006, p. 61).

For example, a client who states that he or she plans to kill himself or herself with a gun must be considered to be at some elevated risk for suicide. But if that person does not own a gun and states that she or he doesn't have access to a gun (for example, from a family member) and doesn't know how to go about getting a gun, then that person is less likely to commit suicide than someone who has recently purchased a gun. If a person plans to use a gun to commit suicide, has a gun and bullets at home, and tells a clinician that he or she is intending to commit suicide on his or her birthday the following week, then that person is at a very high risk of committing suicide and the clinician must take steps to intervene.

Other Conditions Concerning Suicidality and Confidentiality

It is important to note that the clinician would also want to assess other factors that contribute to the possibility that a person is genuinely suicidal -- although in the case of someone like the above described hypothetical patient there would be no significant need to do so, since that individual has clearly passed into the realm of being at extreme risk for suicide. In a more ambiguous case, the clinician would want to consider factors such as previous suicide attempts (which would increase the possibility that an individual would try to commit suicide again) and whether a family member or close friend had committed suicide, as these also increase the chance that an individual might attempt suicide.

The clinician would also want to assess for underlying physical problems that might make it difficult for the person to make rational decisions about suicide. For example, if the patient or client was psychotic or schizophrenic (one could be both, of course) or suffering from a form of dementia, he or she might not be capable of the kind of reality-testing that most of us can do when determining whether or not life is worth living. If they are incapable of making an accurate internal diagnosis, then such individuals must be considered to be at higher risk for suicidality.

Before going on to discuss the ways in which three different types of clinical professionals would assess a patient or client for threats to another individual, which brings us to the issue of confidentiality. With a very few exceptions, anything that a patient or client tells a clinician must be kept confidential by the clinician. This includes information that might seen in commonsense terms to need to be reported to someone else, such as the fact that the client or patient is breaking the law. But mental health professionals, and medical professionals in general, are not members of any police force, and so if a client or patient reports that she is embezzling company funds or that he is blackmailing his ex-partner, these are not things that the clinician is allowed to tell anyone else. (This does not, of course, mean that the clinician would not help the client examine these behaviors and develop better means of coping that do not involve breaking the law!)

However, if a client or patient is harming a child, an elder, or a developmentally delayed adult, or is making a specific threat against a named individual, then the clinician is legally required to report this harm to the appropriate agency (such as Child Protective Services, Adult Protective Agencies, the police, etc.) In a follow-up to the preceding discussion about suicide, mental health and medical professionals are not required to report suicidal feelings and plans to any outer agency, but they are permitted to do so. This is an important distinction: Clinicians are mandated to report harm to others but are permitted but not mandated to report suicidal feelings.

Finally, before I turn to an analysis of the ways in which different types of clinicians approach the process of diagnosis and assessment I want to mention the last but in most cases central set of concerns that a clinician has when meeting with a client or patient. While issues of suicidality and potential or actual harm to others must always be assessed, for most clients and patients these will be absent. What brings most people to a mental health… READ MORE

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