Suicide is the 10th leading cause of death in the United States (Chesnay and Anderson, 2020). Suicide does not discriminate between age, sex, race/ethnicity, and geographical location however, it is 4 times more likely in males than females. The National Action Alliance for Suicide Prevention has put in place an act called, “Zero Suicide”. It is a program used to provide information about suicide risk screening tools and steps to take when a patient screens positive for suicide risk. Healthcare settings have a significant role in preventing suicide when screening during routine appointments. This is due to the large number of patients they see from a variety of backgrounds (King, Horwitz, Czyz, and Lindsey, 2017). There are many tools used to assess for mental health concerns and suicide that is encouraged to be utilized by healthcare providers during routine appointments. These screenings include PHQ-9, PHQ-2, SBQ-R, C-SSRS, and ED-SAFE Patient Safety Screener. The PHQ-9 is the most common and incorporates DSM-IV depression diagnostic criteria into a tool for screening, diagnosing, monitoring, and measuring the severity (King, Horwitz, Czyz, and Lindsey, 2017). Theses screenings would pertain to John because if the provider would have assessed him with a PHQ-9 exam, they would have been able to further determine severity of his mental health and suicidal risk. This would have helped them formulate a better discharge plan other than returning “home”.
What events in John’s life created a “downward spiral” into homelessness and hopelessness? Which events were related to social needs, mental health needs, and medical needs, and which could health care have addressed?
Events that lead to John’s “downward spiral” in my opinion started when he was young growing up with two alcoholics and having an abusive dad. This situation created a high risk for John to abuse alcohol, engage in abusive behavior, and to have mental health issues. His “downward spiral” into homelessness and hopelessness began when he lost his job. The stress this caused him to begin drinking more frequently. With a history of growing up in an alcoholic home, increased stress later in life puts John at a higher risk for developing alcoholism. His alcohol usage then created tension between him and his wife, which lead to arguments and eventually abusive behavior. “Alcohol abuse and alcoholism within a family is a problem that can destroy a marriage or drive a wedge between members. That means people who drink can blow through the family budget, cause fights, ignore children, and otherwise impair the health and happiness of the people they love. Of married couples who get into physical altercations, some 60-70 percent abuse alcohol. In time, family members may even develop symptoms of codependency, inadvertently keeping the addiction alive, even though it harms them” (Watkins, 2020).
Events that were related to his social needs stem from when he was younger growing up with two alcoholic parents and an abusive father. He was neglected of socialization and stability of healthy parents and family life from a young age. His mental health needs were neglected when he was younger as well as through out his adult life. Events that are related to his mental health needs are his childhood, stressor of losing job, engaging in more frequent alcohol use, and becoming angrier and arguing with his wife. At any point, these events could have been evaluated and he could have received help in dealing with these situations rather than letting them progress. Events related to his medical needs did not really develop until after he began engaging in risky behavior and increase in stressors. He was otherwise healthy, other than smoking a ½ pack of cigarettes a day as well as occasional drinking. Health care could have addressed all of these needs in any appointment whether scheduled or an emergency visit through routine examination questionnaires.
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What events in John’s life created a “downward spiral” into homelessness and hopelessness? Which events were related to social needs, mental health needs, and medical needs, and which could health care have addressed? What were some of the barriers John faced in accessing medical care and mental health care?
The purpose of this discussion is to analyze the case study of an individual referred to as John who lost his job, which led to other cascading events and to answer the above questions. Some of the cascading effects including his health situation will be described. John was the sole breadwinner in his home. After losing his job the dynamics of his relationship with his wife who was a stay at home mother was affected. In addition to losing his job, certain events that took place forming a downward spiral for John were his negative coping strategy and losing his family.
Individuals engage in either positive or negative coping behaviors to deal with stressful events in life such as divorce, death, or some other crisis. Whichever coping behavior is chosen, the individual performs these actions as a way of dealing with emotions or how they are feeling (Good Therapy, 2018). Unfortunately for John he chose to manage is stress by drinking alcohol. His situation would only worsen after fighting with his wife, which resulted in her leaving him. John was left alone in a home without a job and therefore could not afford a place to live anymore. This led to his homelessness and hopelessness particularly when he could no longer stay with family and friends due to his increased drinking and anger outbursts.
At the time where John needed a place to stay, he had some support from family and friends, which served his social needs. However, a major part of the problem was the absence of his social needs from his immediate family, which contributed to his downward spiral. John was faced with depression, a mental health need, which worsened as he began to live on the street. Since depression is a common risk factor for suicide (Ng et al., 2017), John expressed hopelessness with thoughts of ending his life. Moreover, increased rates of suicidal thoughts and attempts are common in homeless individuals Substance Abuse and Mental Health Services Administration [SAMHSA], 2015).
John had medical needs due to recurrent skin infections, colds, and injuries which required care. However, now that he was homeless and without a job he did not have health insurance or money, which were barriers that did not allow him to have the medical or mental health care he needed. Had the providers screened John for homelessness and mental illness, his social, mental health, and medical needs could have been addressed. According to SAMHSA (2015), homeless individuals with disorders such as mental or substance use find themselves isolated from social support. Additionally, these individuals need services that provide stable housing, financial help, food, employment, and medical and mental health care. Therefore, John could have benefitted from screening, which is generally performed at health care settings.
Other services that will address John’s needs are suicide screening and preventive services, and early intervention and recovery support (SAMHSA, 2015). US Preventive Services Task Force (USPSTF) has recommended a tool that can be currently used in health care settings to screen for depression. The Patient Health Questionnaire (PHQ) is one of the tools that can allow Advanced Practice Registered nurses (APRNs) to screen for mental health disorders and provide treatment accordingly (U.S. Preventive Services Task Force, n.d.). Another widely used tool to screen for suicide is the SAD PERSONs suicide assessment tool. This tool is a scale with ten items matching the mnemonic that has been noted to enhance identification of individuals with suicidal tendencies. One point is assigned to each letter in the mnemonic which measures in order, sex, age, depression, previous suicide attempt, ethanol abuse, rational thinking loss, social support lacking, organized suicide plan, no spouse, and sickness (Ng et al., 2017).
To conclude, there are many mishaps in life which can cause an individual to become homeless. A strong determining factor is the type of coping mechanism they choose to use. Some individuals engage in maladaptive coping which only worsens the situation. Receiving support from a therapist or mental health professional can help individuals cope with difficult situations and offer better coping strategies (Good Therapy, 2018). Getting this type of service early can prevent downward spiraling of any situation. However, if an individual finds themselves in a predicament of homelessness and poor health, providers can use the opportunity with repetitive acute visit encounters to screen for homelessness, mental health disorders and suicide in order to recognize patients at risk who’s situation may need interception (Ng et al., 2017), early intervention, and recovery support (SAMHSA, 2015).
utilizing at least two scholarly references per peer post. APA format
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