Mental Health and Helping Skills

This assignment identifies a client I have been visiting as part of the BSc (Hons) Community Health Care Nursing – Health Visiting, within a large inner city area. The assignment describes how the client’s mental health needs were assessed and a negotiated plan of care was offered to support the client. An outline of the Health Visiting role is addressed along with the role of others involved in the care. A critical reflection of the experience is addressed with its implications on the role of the specialist practitioner within the wider picture of mental health practice in primary health care.

The assignment is a reflective incident, it is therefore written in the first person singular. 2. The development of a helping relationship To ensure anonymity and confidentiality of the client and family, names have been changed. The mother’s name has been changed to Joanne, aged thirty. The father is Gavin, aged thirty-two. Their eldest son is Oliver, aged two years and newborn girl named Kelsie. Informed consent was obtained from Joanne.

The problem that became a mental health issue began in the period, prior to the birth of Kelsie. During the monthly meeting between the Health Visitor and Community Midwife, issues were raised regarding Joanne’s low mood. She had refused treatment for anxiety, stress, and/or depression as she felt she was coping. Following the meeting, I had a lengthy discussion with my CPT – it was concluded that Joanne presented a suitable case for me to visit professionally, both ante-natally and post-natally.

2.1 The Ante-Natal Visit Joanne was contacted and an ante-natal visit arranged. The ante-natal visit is designed to establish a relationship, introduce the perspective of Health Visiting and hopefully, identify any factors creating vulnerability in the family (Robotham and Sheldrake, 2000). I discussed with Joanne the role of the Health Visitor, explaining that I would visit her and the baby post-natally in their home for as long as she needed and thereafter at the clinic. Support services within the practice area were portrayed and I explained that I would ask her to complete the Edinburgh Post-natal Depression Scale (EPDS) questionnaire between the sixth and eighth post-natal weeks (Cox, Holden, Sagovsky, 1987). This would be undertaken in order to determine her mental status over the previous week (See Appendix 1,2,and 3).

Joanne described her pregnancy as difficult. She suffered nausea and vomiting, and had been a hospital in-patient at 9 weeks of pregnancy, being prescribed anti-emetics and an intra-venous infusion for 5 weeks. She also stated that she felt that she was not a good mother to Oliver. When asked about this she felt that being a working mother was hindering Oliver’s development (Oliver’s developmental checks had been undertaken and everything appeared to be normal). Gavin had been unable to help, as he had been working extra shifts. Harvey (1999) describes a symptom of depression as feeling that you are not a good mother or you are not taking care of the baby.

Joanne and Gavin have few friends and no family in the area. Joanne’s mother lives in Liverpool, visiting Joanne and family fortnightly. Joanne has no contact with her father. They appeared to have minimal support from friends and family. These factors contributed to Joanne’s bio-psychosocial needs. With all this information I completed the health needs assessment of the family. In 2001, Deaves suggested that prevention of post-natal depression (PND) should begin in the ante-natal period, primarily identifying predisposing factors. These include social and psychological i.e. previous PND. Social factors include bereavement, difficulties with relationships – particularly supportive relationships, and inadequate social support.

Green and Murray (1994) surveyed literature assessing the extent of depression during pregnancy, concluding that prevalence rates of depression during pregnancy were equal to those after delivery. Following on from this they used the EPDS (See Appendix 1, 2 and 3) to record scores during the ante-natal period, comparing them with post-natal scores, they found a close link between the two periods.

Through personal reflection and discussion with the Community Practice Teacher (CPT), the situation was critically analysed, concluding that Joanne would benefit from extra support. However, on being approached Joanne declined extra support stating that she would be happy to see me following the birth of the baby. 2.2 The Birth Visit The following week my CPT received notification of Joanne’s delivery and I arranged a birth visit; a visit designed to discuss the positives and negatives of the birth experience. Describing the birth experience as being positive, Joanne however, felt that the labour was too quick; 11/4 hours from the 1st contraction to delivery of the placenta, with no time for any pain relief.

During this visit, it became evident that meaningful communication between Joanne and Gavin was lacking, both verbally and non-verbally. Research shows that women can experience feelings of being alone and without support from about 31/2 weeks post-natally (Eastwood, 1995). Rickitt (1987) states that women in unsupportive relationships are more likely to experience feelings of isolation, and, a woman without a close, confiding relationship is nineteen times more likely to develop post-natal depression. With this research in mind and Joanne’s previous history, I felt it necessary to meet Joanne to discuss ways of relieving any possible anxieties/stress. Accordingly a home appointment was made to see Joanne by herself.

2.3 The Second Post-Natal Home Visit On arrival for the visit Joanne was extremely cheerful and appeared very organised. The house was exceptionally clean and tidy and Oliver was sitting quietly watching television. However, the atmosphere felt very tense and Joanne appeared not to want to talk. The visit quickly came to an abrupt end by Joanne stating she had to go out. Through further reflection and discussion with my CPT It was agreed that by involving her G.P. a multi-disciplinary approach to Joanne’s care would be created. In practice, this would result in professional collaboration of meetings and ultimately joined up working (Fatchett, 1998).

As a specialist practitioner, there is a need to develop skills of effective listening, in order that help can be provided by allowing clients to talk and identify their health needs (Ewles and Simnett, 1995). Rollnick, Mason and Butler (2000), state that the acquisition of listening skills requires practice and self-awareness of what is being achieved and how the patient responds, they also state that it is easy to allow the attention to wander, either by thinking about similar experiences or interrupting and agreeing or disagreeing. Beginning with the aforementioned visit and continuing with the following visits, praise was seen as being a successful tool. Praise and encouragement would, hopefully, enable Joanne to look at her lifestyle more globally.

Through further reflection with my CPT and Joanne’s G.P, I was able to critically analyse the situation. It was agreed that Joanne would benefit from extra support and listening visits could provide her with a method of moving forward. Joanne …

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