Jack Jones is a 42 year old man who has had several psychiatric admissions, his first when he was 18 while he was in his first year at university: PATIENT CARE ESSAY, Australia

PATIENT CARE ESSAY – SCENARIO

Jack Jones is a 42 year old man who has had several psychiatric admissions, his first when he was 18 while he was in his first year at university. Over the past 9 years he has been declining in his ability to live in the community. After a 10-day admission, Jack is almost ready for discharge from the psychiatric unit in which you are working. Prior to Jack’s admissions to hospital he repeats a similar pattern.

He often ceases to take his medication, risperidone 4mg BD. He states that he stops the medication because of the extra-pyramidal side-effects, dry mouth and blurred vision that are “sometimes unbearable, and at times, are worse than the psychotic symptoms”.

Shortly following this he begins to believe that he is being talked about on the radio (derogatively) and hears voices telling him that the government is monitoring his every move via a tracking device. When Jack is ill, he believes this device was implanted during his first admission. Just before this admission he went to the police to ask them to “find out who put it there and to lock them up in prison”.

Jack lives in a large men only hostel in the community supervised by an unqualified home care assistant. “I like it because it is cheap, I can spend my money on what I want, and they don’t hassle me”. He has recently been unable to keep regular employment as a labourer on building sites, and is hesitant to apply for any job for fear of being rejected or eventually sacked.

Jack also believes that he should have a girlfriend but often expresses feelings of intimidation and anxiety when approaching women. He has a highly ambivalent relationship with his family, whom he says “shout and argue all the time”.

They live in a remote country town and keep asking me “when am I going to find a nice girl and get married, and have someone to look after me”. A week ago, Jack’s treating team decided to switch his medication from risperidone to paliperidone palmitate monthly.

Briefly outline two priority problems for Jack and discuss the role of the community mental health nurse in enabling someone like Jack to live in the community and avoid unnecessary hospitalizations.