1. Co-morbidity impact on the clients’ overall physical and social functioning
By considering the first letter of Peter’s mother, it is noted that in the initial stage, which is during the school days, Peter experienced some problems, however, that was not that serious as the letter suggests that Peter was a bright student in the school around the age of 14. Moreover, peters’ engagement in extra circular activities seemed to have had inflicted positive impact, however, once peter got drunk and was required to be admitted to a hospital overnight as the level of drunk was extreme.
The symptoms further suggested that Peter had depression issues, however, Peter did not want to get medical help as Peter refused to see a psychiatrist. Although, Peter did manage to fight depression and was able to graduate and become a high school teacher. Still, within the five years, it has been noted that during the university years peter displayed certain behaviours that indicated mental issues such as self-harm and attempt to commit suicide. By the time, Peter was 20, Peter moved out of town to work as a teacher and as per the letter provided by Peters’ mother, and by that time, Peter experimented with amphetamines along with other drugs. It was during this period that Peter was totally into substance abuse and was labelled as schizophrenic and a drug addict.
Due to the said issues, Peter also faced challenges in performing the job in South Australia. As per the letter provided by the school authority, Peter had a positive relationship with the school kids and other colleagues, however, due to Peter’s mental state the school authority was concerned about Peters’ well being. Peters’ ignored the same when the principal asked about Peter’s health, yet, Peter showed signs of mood swings and was often late for school and also seemed to be tearful and irritable.
As per Peters’ doctor, Peter decided to cure himself and tried to get rid of substance abuse by focusing on the future of his daughter. In doing so, Peter proactively took certain actions by admitting to a detox programme. Peter has undergone both private and public treatment, however, since the community treatment order Peter has shown sign of recovery. Peter’s doctor also initially gave quetiapine, which was later reduced to 50 mg BD after Peters’ discharge from detox admission from DASSA.
Thus, based on the clinical situation of Peter, the illustration provided by Opare-Addo, Mensah & Aboagye, (2020) on theories of diagnosis of mental health issues is that individual suffering from Schizophrenia Disorder are more likely to consume the substance in comparison to an individual without such issues. Thus, studies have revealed that Schizophrenia Disorder patients have an inclination to drink heavily or smoke and indulge in drugs intake. Hence, from the statement provided, it can be justified that Peter had shown the symptoms of substance abuse in the initial stage of school days as it resulted in Peters’ hospitalisation. Moreover, another hypothesis given by Kilian et al. (2020) on the study of Schizophrenia Disorder has made a clear assumption that in most cases the patients with Schizophrenia Disorder tend to have a notion that using or indulging in substance abuse can treat their condition and provide a feeling of improvement from within. Therefore, Peter during the university days also indulged in amphetamines and other drugs, which as per the letter provided by Peter’s mother made Peter lose weight and become psychotic.
Another study conducted to determine the relationship between Schizophrenia Disorder and substance abuse by KELKAR et al. (2020) has highlighted the high possibility of co-morbidity of Schizophrenia Disorder and substance abuse among such patients. According to the study, it has been noted that almost moiré than 50% of Schizophrenia Disorder patients have been found to have indulged in drugs or alcohol disorder. In this context, Chiappelli, Chen, Hackman & Hong, (2018) has stated that the impact of substance abuse gets significant as in most cases lack of early intervention is not evident. Therefore, with the objective of mental first aid, it has been noted that early intervention in the case of Peter was evident as Peters’ parents appointed psychiatrist, however, Peter did not follow through, which caused Peter to face various challenges until the last recovery.
Various causes and incidents have been associated with the link between Schizophrenia Disorder and substance abuse. However, self-medication as per Roscoe, Lery & Chambers (2018) is one of the highest cause of the current link, which is done in order to deal with social anxiety or psychosocial disorders. Thus, in this regard, various treatment methods are begin initiated from both private and public organisations to reduce the problem and ensure zero substance abuse among patients with Schizophrenia Disorder to further reduce cases of co-morbidity (Krakowski, Tural & Czobor, 2021).
2. Guiding principles underpinning the South Australian Mental Health Act (2009)
The principles or the guiding principles under the Mental Health Act 2009, is based on highlighting the duties of the officers in the process of assisting a patient with mental health issues. Therefore, based on the case study of Peter, the two guiding principles can be stated here as per its relevance with the case. Thus, first in terms of service, which is “provide service on a voluntary basis wherever possible”, secondly, in terms of officers’ duty is to “provide information to persons (and families and carers) about mental illness, treatment orders, legal rights, treatments, services and alternatives”.
Hence, Peters’ parents are seeking ways to improve Peters’ condition and are looking for aid in a professional manner. Therefore, it can be stated that the letter from Doctor Joshua can help in the first aspect, which is continuous monitoring of Peters’ health condition, even though Peter does not like the same. Moreover, the doctor stated of relapse as the doctor might suspect that Peter may have again taken substances. However, the doctor asked the care manager regarding up-to-date on Peter’s health status, which fulfils the first principle of offering treatment wherever possible. In this context, it can also be stated that Peter hesitated to undergo the treatment, which indicates that the treatment begin received by peter is involuntary. The Community Treatment Order prescribes the health or relevant officers to provide treatment to individuals such as Peter as the CTO policy states that such individual are not well enough to undertake decisions about treatment.
The second principle stated in the case of Peter is the access of information of the patients’ health status by the families and carer. The reason for the same is due to the fact that close families and carer are the individuals that can assist the patient in the event when the doctor is not around, hence, these individuals also requires proper awareness and education regarding the actions to be taken while dealing with patients that are family members or close friends. Moreover, under the CTO or Community Treatment Order illustration, such patients can live within the community, however, the patients will have to comply with the CTO guidelines and conduct regular or periodical check-ups with the assigned doctors in order to ensure self well-being as well as the well-being and safety of the individuals within the community. Thus, in the case of Peter, it is essential to comply with the CTO guidelines in order to ensure that Peter can spend more time with his daughter.
3. Recovery oriented approaches or services to support Peter and the carer
Recovery oriented approaches under the NSW health and service policies, Australia, states that rehabilitation in a properly structured manner is a service towards supporting individuals like Peter to tackle mental health challenges. In doing so, the policy or the service offered by the state intuitions in South Australia highlights different types of rehabilitation among which psychosocial rehabilitation focuses on the individuals’ ability to function within the community. The rehabilitation process is executed with an integrated effort from both private and public organisations. In this aspect, the policies of such services consider the development of a treatment framework that enables the patients or the carer to self-manage the activities for recovery from mental illness.
Specific to the case of Peter, it can be said that the service type that can be effective for Peter and Peters’ carer will be an integrated model that can deal with both Schizophrenia Disorder and substance abuse. According to the model suggested by, Schizophrenia.ca. (2021) the integrated treatment process should be assertive in its outreach and should focus on the high engagement of the patient. Apart from that, Nielsen et al. (2017) has suggested motivational therapy, which is based on defining the patients true self and establishing goals and objectives that foster personal growth of the patients triggering a sense of need for self-improvement.
In the case of recovery oriented services, the suggestions of Mørkved et al. (2018) can be considered in the case of Peter, which is to focus on elimination of substance abuse rather than implying actions to control the same. In this aspect, Kendler et al. (2019) has stated that a clear recovery plan or a particular service model is yet to be identified in case of treating patients with mental illness, however, the carer can put focus on areas that help the patient to be motivated and feel the urge to be recovered. In the case of Peter, it has been noted that Peters’ willingness to recover is evident due to Peters’ love of his daughter and Peters’ willingness to spend more time with his daughter. However, in the case of the carer, it is suggested to have patience as most of the time in the process of treating the patient the carer may identify relapse. Therefore, it is important to consider that the process of treating the patient with Schizophrenia Disorder and substance abuse can be highly complex and requires a long terms perspective to achieve quality improvement and gain the possibility of proper recovery.
Accordingly, the psychosocial recovery process focuses on collecting the strengths and learning ability of the patients at a different level, which can be further used to develop a customised framework for patients to achieve fast recovery (Florentin et al. 2021). Further, in the case of the carer, it is suggested to be more aware of the particular type of mental illness faced by the patient. Begin aware enables the carer or the family to undertake relevant steps or actions to deal with the patients and have a better form of communication with the patients. Communication also improves by begin aware is due to the fact that the carer or the family members are able to identify the exact needs and wants of the patients and accordingly cater to those needs and interest (Taipale et al. 2021).
Apart from that, the role of the community is highly significant in the recovery process of patients with mental illness or Schizophrenia Disorder and substance abuse (Mascayano et al. 2021). It has been noted from the letter sent by Peters’ mother, wherein, it has been stated that in the initial stage Peter had undergone several treatment procedures, however, begin unable to recover the hospitals labelled peter as a Schizophrenic and drug addict. Moreover, it has also been noted that Peter was called or abused by different names. This attitude of the community towards patients with mental illness causes further consequences as the description provided by Peters’ mother Peter heard voices, hallucinated, and spoke in different voices. These attitudes cause patients to be more fragile and lose confidence to improve and thus indulge in substance abuse to be aloof for society and community (Alegría et al. 2021). Thus, it has been suggested to the carers to have patience while treating individuals with Schizophrenia Disorder and substance abuse (Spencer et al. 2021). Moreover, it is also the duty of the family and carer to provide positive feedback and have a positive outlook towards patients with Schizophrenia Disorder and substance abuse in order to ensure that such individuals can live within the society with dignity and respect (Florentin et al. 2021).
