Case Study

Case Study

Case Study

Case Overview

Lucy is a 15 year old girl who was admitted to Bluebird House under section 3 Mental Health Act 1983 from a privately run hospital. Lucy has a diagnosis of emerging emotionally unstable personality disorder. She is currently on 15 minutes observations and is no lone working. She spends a fair amount of time in high care/seclusion due to her violent behaviour towards staff. At present she has car leave for 30 minutes twice a week. She has no contact with her family apart from her maternal aunt, with whom she has regular phone contact. Family History:

- Lucy is a looked after child with social services and her mum has joint parental responsibility.

Lucy has a number of half and step siblings. Her dad committed suicide when she was 5years old. She lived with her mum and stepdad until the age of 12.

Personal History:

Lucy has a history of violent, verbal aggression and physical aggression towards others. Lucy's mood fluctuates significantly within the period of a few hours. She is impulsive and self harms. Lucy was aggressive towards other children from the age of 3 and was excluded several times in her first year of primary school. She was excluded from secondary school 3 times due to her threatening and abusive behaviour towards teachers and peers. In 2008 Lucy became known to CAMHS due to difficulties in managing Lucy's behaviour. Subsequently Lucy was placed in four care establishments before being admitted to Bluebird House.

Diagnosis:

Lucy's symptoms are consistent with a diagnosis of emerging emotionally unstable personality disorder. Due to her age she does not meet the diagnostic criteria for emotionally unstable personality disorder (ICD-10). I have decided to focus on this particular young person as I am Lucy's associate nurse. She appears to have significant attachment issues.

Risk Factors-

Family history of mental health illness (Mum had post natal depression, Dad committed suicide) Poor attachments (difficult relationship with mum and siblings, looked after child in 2008, 4 different secure units) Poor school achievement (moved schools, excluded for short periods) History of violence towards others (Aggressive from the age of 3 towards siblings and peers. Threatened to kill her mum with a knife) History of self harm (ligatures, suicidal thoughts, head banging, punching walls, attempt to jump from a balcony) Low empathy/remorse

Management Plan:

The management plan for this case is divided in two parts, the first one is short term and the second one is long term.

Short term

In short term planning there would be a observation levels of 15 minutes due to self harm. In this case there wont be alone working with patient due to aggression and allegations towards staff . in this case we use C &R techniques and high care and seclusion for containment (therapeutic and or safety of both Lucy and others) . all the recommended medicine with the primary aim of causing sedation and reduction of her violent behaviour. There would be a structured day to include education and room ...