Scenarios

Chapter 15: Health promotion and people with mental health issues

Jack is a 28-year-old male who was born in Uganda and came to live in London when he was 4 years old. Jack lives with his parents. Jack's father is a pastor in a Christian community and his mother is a secretary in a local primary school. He has one brother and two sisters.

While at medical school, Jack found the subjects and commitment required for his chosen career to be very stressful and difficult to manage. In his fourth year, Jack told his parents that he was gay which created much upset and distress in the family and continues to create a strain on their relationship. This further added to his stress. Jack became ill and was diagnosed with Schizophrenia. He had to leave medical school six months before he was due to qualify.

Since then, Jack describes his life as a "downward spiral". He has experienced abuse because he is gay and mentally ill. He has stopped going out, does not have any friends, feels ashamed, worthless and feels hopeless. Since commencing his medication four years ago, he has noticed that his weight has increased dramatically, he is lethargic, his blood pressure has increased and recently investigations suggest that he has diabetes. He also has sickle cell anaemia which is very painful and sees the specialist nursing team at his local acute hospital for treatment.

He sees his practice nurse every other week for his hypertension and his General Practitioner for a repeat prescription every month. His community mental health nurse who is also his care coordinator administers his depot injection every two weeks and provides support for him. Though Jack looks forward to his visits, he says that often the conversation that ensues between them centres on monitoring of symptoms and his illness.

• 1. How could you work with Jack to improve his health and well-being?

  Show Answer

  Correct answer:
  The priorities for Jack will be self management of his diabetes, building his self-esteem and awareness and problem-solving skills to encourage him to go out and increase physical activity.
  His physical health disorders have the propensity to contribute to mental health whether this is through pathological, psychological or social processes that people experience. Being tested for diabetes may trigger anxieties, that in turn will impact on other stressful emotional and physical illnesses. Prolonged exposure to stress hormones can be damaging and lead to other conditions such as coronary heart disease and strokes. Hypertension and psychotropic medication means Jack is at increased risk for coronary heart disease. Side-effects of psychotropic medication may impact negatively on his circulatory system and can lead to iatrogenic (illness caused by other treatments) conditions. Pain will impact on his emotional state and may discourage him from socializing and contribute to the "downward spiral" description that he considers exemplifies his life.
  In Jack's case, it may be that his sexuality conflicts with his religious beliefs and therefore negatively impacts on his emotions. His psychological feelings of hopelessness and shame exacerbate his physical conditions. Together these impact on his social life and his opportunities for employment. Not going out reinforces his feeling that there is no hope and his belief he will always be abused when he goes out.

• 2. What protective factors might there be for Jack's mental health in his social environment?

  Show Answer

  Correct answer:
  His family, the specialist sickle cell anaemia nursing team, practice nurse, the general practitioner and his community nurse. Each of these can make significant contributions in helping Jack improve his life and health particularly if a coordinated approach is taken. Within mental health services, care coordinators are appointed as the main on-going support and contact person for those who have continuing needs. Jack's care coordinator is also his community mental health nurse (CMHN) and so he would be ideally placed to coordinate his health promotion needs as part of his care arrangements.