Running head: JOURNAL
Journal
Author's Name
Institutional Affiliation
JOURNAL
Recommended
Behringer, B., & Gilbert, H. F. (2006).Appalachia: Where place matters in
health.Preventing Chronic Disease: Public Health Research, Practice and
Policy, 3(4), pp. 1-4.
Bilinski, H. N., Duggleby, W., & Rennie, D. (2010).The meaning of health in rural
children: A mixed methods approach.Western Journal of Nursing Research,
32(7), pp. 949-966.
Erwin, P. C., Fitzhugh, E. C., Brown, K. C., & Looney, S. (2010). Health disparities
in rural areas: The interaction of race, socioeconomic status and
geography.Journal of Health Care for the Poor and Underserved,21(3), pp.
931-945.
Freydberg, N., Strain, L., Tsuyuki, R. T., McAlister, F. A., & Clark, A. M. (2010). ‘‘If
he gives in, he will be gone...’’: The influence of work and place on
experiences, reactions and self-care of heart failure in rural Canada.Social
Science & Medicine, 70, pp. 1077-1083.
Leipert, B. D., & George, J. A. (2008).Determinants of rural women’s health: A
qualitative study in Southwest Ontario.Journal of Rural Health, 24(2), pp. 210-
218.
Thumanth, M. (2016).The role of street nurses in increasing access to health
care for marginalized populations.Association of Registered Nurses of British
Columbia.
Rural Health Information Hub. (n.d.).;Healthcare access in rural communities.
Robert Wood Johnson Foundation. (2010).Rural nursing facing unique workforce
challenges.
Home & Community Based Services
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Homeless with Mental Illness
Speaker 1:Whoa. We're about to get onto the freeway. LA. The City of
Angels. Palm trees, sun, and beautiful people. But there's another side to
this city. There are places that tourists should never go. Places even
locals try to avoid. This is Skid Row, a place referred to as America's Only
Third World City. It's home to hundreds of homeless people. Many of
whom are mentally ill or impaired. We'd been warned but nothing prepared
us for what we saw as we cruised the streets leading to the heart of Skid
Row. We've filmed in plenty of places, but we were surprised how bleat
and frightening this place is.
Film crews aren't welcome here, and none of us wanted to get out of the
van. Our first destination was the Union Rescue Mission. It's the largest
and oldest organization in the USA working to support homeless people. It
was started by the founder of Union Oil, Lyman Stewart, 118 years ago.
Rev. Andy Bales:Skid Row in LA, which is really like one of the worst
human disasters in the US, and it's really been caused by corralling and
containment of people who are struggling with homelessness.
Speaker 1:Thirty percent of homeless people in the US have some form
of mental illness. If you're poor and mentally ill, you have few options
before you hit the streets, or jail.
Rev. Andy Bales:And you never know which came first. Sometimes, the
mental illness comes and leads to homelessness, but certainly prolonged
homelessness and suffering devastation on the streets, being robbed and
beaten and mugged, and if you're a woman much worse, certainly leads to
depression and other issues of mental health. So, we've got to make sure
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that we don't leave one precious human being on the streets. That's really
the bottom line.
Speaker 1: Andy takes us to what feels like a disaster zone. He makes
regular trips here handing out water. He's insisted on bringing eight
minders along to make sure our cameras don't upset people. But, I wasn't
prepared for the barrage of people coming up to us.
Rev. Andy Bales:Gotta couple of guys, and then we'll head back this
way. Hey, you wanna water?
Speaker 3:No.
Rev. Andy Bales:No?
Speaker 4:Hey what's up United States Marine Corps. My name is
Lunatic. I'm gonna say Julia right there. We live, yo.
Speaker 1:According to the 2007 statistics, up to 142 thousand men,
women, and children become homeless over the course of any year. Up to
74,000 people are homeless each night in Los Angeles County. Half the
homeless are single men. 25 percent are single women, and the rest are
entire families.
Speaker 5:Thank you. Have a nice day.
Rev. Andy Bales:We are the capital of homelessness. We have more
people on the streets than any other city. Double of what New York and
Chicago have combined. Every suburb, every region, every city has kinda
dropped off their folks who are struggling in this spot in LA, and forgot
about them. We're not living up to the City of Angeles, and we've gotta
work towards the day that we don't have one precious human being on the
streets and that's gonna take a lot of work but mostly it's gonna take a
heart change. Hey guy.
Speaker 1:What sort of feeling does this give you, any?
Rev. Andy Bales:Just encouraging to give folks a cold drink of water and
a little bit of encouragement and some hope.
Speaker 1:'Cause to get through the day for you, you see a lot of
sadness. Is this just getting you through? Doing stuff like this?
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Rev. Andy Bales:Yeah, it helps. But really helps is when somebody gets
a bottle of water and then they decide later on, because they know where
the water came from, they come in and ask for real help.
Speaker 1:Andy once spent the night out on the street, just to see what it
was like.
Rev. Andy Bales:I think I slept like 30 minutes because a guy said he'd
watch my back, you know. But that's all I got. A friend of mine who spent
20 years said "Andy, after six or seven days that fear would have been
replaced by anger, and you would have adapted 'cause humans adapt to
anything." We realize that precious people, they're somebody's aunt,
they're somebody's uncle, they're somebody's precious baby that they
held in their arms and we need to quit referring to people as the homeless
or the drug addicted.
Speaker 1:It's hot. A dry, searing kind of heat. We've only come about
maybe 50 meters. We've handed out over 200 bottles of water. It's gone.
Rev. Andy Bales:We experienced a tsunami of families in this latest
economic downturn. And about 53 percent of the families who came our
way were experiencing homelessness for the first time in their life. They
lost their home. They lost their job. They lost their apartment. They ran out
of funds. They ended up in a hotel til their savings were gone. Then they
moved to their car. And then the last stop was a place like Union Rescue
Mission. And we've relaunched probably about 45 families, including I
think three are getting relaunched this week because we didn't leave them
in homelessness long enough to suffer the devastation of homelessness.
You would not have wanted to visit here before the Safer Cities Initiative.
You couldn't, I couldn't walk down the street without having to break up a
serious pipe fight or knife fight. It was described as Mardi Gras on crack.
Speaker 1:Right.
Rev. Andy Bales:And, it was very dangerous. And now, you can see we
can walk down the street pretty safely and without the police we couldn't
do that.
Speaker 1:Yeah.
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K. Davis-Walker:This is our day room for our male folks who come in
and are staying with us. And they can come in and just have some quiet
time just to get off the mean streets down here on Skid Row.
Speaker 1:People can sign up for beds, enjoy three meals a day, and
take what might be their first shower in weeks.
K. Davis-Walker:Good morning, sweetie. How are you?
Speaker 1:Haircuts are provided, along with fresh clothes and medical
care. Therapists are on hand to assist the mental state of those who turn
up here, and work out an action plan. The Union Rescue Mission provides
a real opportunity to get off the street and start a new life.
K. Davis-Walker:This wall is the wall where, when folks come in, and
they're sick and tired of being sick and tired, and being on the street and
they want some help, they sit in these seats for about 14 days. That lets
us know that they're really serious about getting some help. It's full every
night. This place holds I think about 160 single women, and we're full,
we've overflowing. And so, we put out cots in the area downstairs, the day
room, for the women as well as the men. That's our overflow.
Speaker 1:So, how long essentially would somebody stay here?
K. Davis-Walker:Normally it would be a month and then after a month,
you have to either try to get in one of our programs to try and get off the
street, or just go away and stay somewhere else. But because we've had
to break, bend the rules a bit, because we really have nowhere to send
anybody. We've had to let them stay a little, a lot more than one month.
Speaker 1:It's like 160 odd beds here, and as you can see, most of them
are made, which means that somebody's coming back for the night.
There's very few that aren't made. This place is full, and overflowing.
Yeah. The question going around in my head is "Why are all these people
here?" For many, the bottom has fallen out of their life. But a whole lot of
people living here are mentally ill. Hospitals have even dumped unwanted
mentally ill patients out here on the streets.
Rev. Andy Bales:Got to, I was standing out front and a cab pulled up, did
a U-turn, dropped a woman in a nightgown in the middle of the street, and
she started wandering this way. And I called the police and sent a staff
person to rescue the lady off the street. We had a videotape of that from
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our cameras, and that played all around the world. And it was the first time
it had been documented that hospitals actually drop off patients. She was
from 20 miles away. So they dropped this woman off in her hospital gown
in the meanest streets of Skid Row. She had dementia, she had high
blood pressure, and a fever. And if we wouldn't have seen them drop her,
we wouldn't have rescued her. She would have been on these streets.
And the hospitals were fined, and they set up a protocol. My wife and I set
up a special referral sheet that they get properly referred, and can we or
can we not take care of the needs of that patient? Yes or no? And set up a
system.
But then, we found a man wandering around out here who had nine
prescriptions for antipsychotic medicine. And he'd been dropped off by a
mental hospital 40 miles away. And the city attorney looked into it, and
found that 155 mental patients had been dropped off on these mean
streets in 22 months. And they were fined 1.6 million dollars. And now
there's a city law banning the dumping of patients in Skid Row LA and
South LA. And that's the thing doctors are sworn to do no harm, and yet
hospitals were dropping the most vulnerable people in our society off on
these meanest streets really in the country.
Speaker 1:Sharon Cameron was homeless for nearly 25 years, and has
struggled with mental illness and drug addiction most of her life.
Sharon Cameron:I would just grab anything to make what I was feeling
go away. It's ending, your body is burnt out. My slogan was I felt like I was
dipped, cooked, and fried and the only thing left was to toss me to the
side.
Speaker 1:You used to sleep here?
Sharon Cameron:Yeah used to sleep here. If you notice, people still
sleep here. All back here. Because it was safe. It was not too light and not
too dark. And you know you could kinda peek up and see what was going
on.
Speaker 1:And it was warm?
Sharon Cameron:No, it was cold. In the summertime, it was okay. But it
was hard.
Speaker 1:What did you sleep on, cardboard or something?
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Sharon Cameron:No, in the rain, we put the cardboard up. But they see
they don't allow that here. This is a public library.
Speaker 1:When you're laying here, what are you thinking? This is the
worst thing in the world or what?
Sharon Cameron:Actually, I didn't have no thoughts. I just stared at the
sky. See, I was not only homeless, I was gone mentally. It was, just
existence. Just balled up in a knot existing. Worrying about who gonna
hurt me of course, who's gonna, you know men take advantage of women.
When you first pass out, I passed out, like I said, I'd go to sleep. I passed
out. And I just came to. Can you imagine? And you know, sometimes I
didn't really know where I was. I didn't, oh God. It's an indescribable
feeling. That's when you go off into a depression deeper and deeper and
deeper and just wish you never wake up. And of course the suicide comes
with that. And I just kept trying and kept trying so I just got disgusted. I
said I can't live and I can't die. So, I existed.
Speaker 1:So, how long did this last for? How long were you on the
streets for?
Sharon Cameron:This lasted almost 20 or 30 years off and on.
Speaker 1:Just to get a bit of background, you're one of nine children.
That must have been tough growing up.
Sharon Cameron:Yes, I have three older than me. My oldest sister
committed suicide at 25. I was really jealous because she succeeded. But
not no more. Then my brother. He's in Seattle. He's doing well. And then
my sister, Deborah, I'm trying to help her. That's the one sleeping on 65th
and Western, and it's really bad. And then come me. And then five little
boys up under me, and they all have different fathers. So that lets you
know that environment with these men, these men coming in. You know
what I'm saying? I love my mom. She was young. I'm not the one to talk
about, she was young and she made a lot of mistakes.
Speaker 1:Trouble started for you pretty early. When were you
diagnosed?
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Sharon Cameron:Well, I knew something was wrong. I knew something
was wrong because everybody be smiling and I didn't get that. It didn't
look like the sun was shining to me. It hurt my stomach.
Speaker 1:When was the moment you said "I can't do this anymore? I've
gotta do something about this. I'm 50 years old now."
Sharon Cameron:I went downtown, and I just took all 60 of those pills,
and I said a prayer. I never forgot to pray though. Never. I talk on the cell
phone. It didn't even work. Lord where are you? Please come help me.
So, I took the pills and I just prayed. Then I just froze. I didn't even go to
sleep. So, that's when I realized I can't live and I can't die. That part I knew
clear. That's about the only thing that made any sense to me. I kept
thinking this man up here got a plan for me. 'Cause I really don't wanna be
here, and I don't know how to live. That's a cold situation there. So, that's
when I went to the Excelsior House. It's a great place too. I just love these
programs.
Speaker 1: You can spot 'em can't you? So many people are needing
help that counselors are struggling to reach them all. Sharon needed to
take the first step. This room, you have a lot of fairy lights, huh?
Sharon Cameron:Yes, every day is Christmas to me now. I love this
place called Earth. Look, everything is peaceful.
Speaker 1:Sharon's been off the streets for just a year. She now works
for a peer advocate for the treatment center that saved her. Every day for
you now is like you know you wake up and it's familiar.
Sharon Cameron:Yeah, I'm just ready to help someone. You see, as I
climb, I gotta have something in my hand. And my doctor and my therapist
told me don't overdo it. But he got me.
Speaker 1:Now Sharon's eagerly helping as many homeless people as
she can. She has a spare bed setup for the homeless people she picks up
off the street.
Sharon Cameron:This is Jesus carrying me. If you notice, he's carrying
me through the storm, the rain, the quicksand. I mean there's every, you
can see it yourself. It is what it is. Look at that. Beautiful. Do you know I
have a problem with, this is what I'm afraid for me? 'Cause I feel like I
don't deserve anything. Every time I would do good, and then I'd make
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sure I kick myself down. And I'm really aware of that now so I'm really
watching myself now and I'm talking about it to everybody that will listen
and have that feeling in their heart.
Speaker 1:This is your sister?
Sharon Cameron:Yeah, that's my sister and this is me. She was about
eight.
Speaker 1:And she lives on the street?
Sharon Cameron:I would like for you to see her. Maybe she could—
Speaker 1:Maybe we can go today and see her.
Sharon Cameron:I sure hope so. I really need help with her. But I'm
doing. So you can really see what's going on. It's—
Speaker 1:What is going on with her? She's—
Sharon Cameron:She's delusional. She's sick physically, mentally,
substance. She's just broken. She's another me. How I was.
Speaker 1:Really?
Sharon Cameron:Yeah, and I'm trying to take some of this stuff, these
tools that I have, and I'm trying to spread them all over the world now. And
she just happen to be my blood, but I just wanna share the gift of life with
someone else.
Speaker 1:I like that. Somewhere out on these streets is Sharon's sister,
Debbie, or Angel as she's known on the street. And she's lost in the City of
Angels. How ironic is that? We decided to try to find her. We head south of
downtown LA to a area most people will have seen on the news, but there
are few good news stories out of South Central LA.
Sharon Cameron:Every other corner you see a liquor store or a church.
Speaker 1:Yeah.
Sharon Cameron:And that's only in this, in the black neighborhood.
Speaker 1:Right.
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Sharon Cameron:And they sell Cisco wines, really cheap wine—
Speaker 1:Yeah.
Sharon Cameron:That cause you to run real quick and sick.
Speaker 1:Sharon is a success. But hers is a rare success story. It's all
too easy to virtually disappear to the vastness of this city.
Sharon Cameron:We getting close to her. We are.
Speaker 1:Sixtieth.
Sharon Cameron:Let's see. I think that's where Deborah sleeps back
there.
Speaker 1:Lot of trash.
Sharon Cameron:Sixtieth Street. Yeah. That's where she sleeps back
there. My mother died when I was 21, and I had the 13, 14, 15 year old
kids to raise.
Speaker 1:Yeah. Where was Debbie at that time?
Sharon Cameron:Deborah was already messed up. She was, from the
age, see Deborah was abused really bad. I was sleeping up under the bed
when Deborah was being raped. I was like seven, I mean I was like five
and she was seven.
Speaker 1:Yeah.
Sharon Cameron:So, that's another reason why I'm so determined to
help her because I know what happened to her. I saw it happen. And then
she'd tell somebody and my mother'd say "What goes on in the house
stays in the house." So I said I didn't see anything. So, can you imagine all
of that piling up on her inside as a little bitty girl?
Speaker 1:Yeah.
Sharon Cameron:Gonna ask her. Hi, you seen Angel? You haven't seen
her? She also sleeps in Compton too.
Speaker 1:Yeah.
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Sharon Cameron:Yeah.
Speaker 1:How does she get there?
Sharon Cameron:Huh?
Speaker 1:How would she get there?
Sharon Cameron:Panhandling. See, last time I picked her up, she was
on that porch right there asleep, in the rain.
Speaker 1:As we search for Angel, we come across one of Sharon's
friends still living on the street.
Sharon Cameron:If it'll help somebody, we trying to get some help off—
Speaker 8:No, we just did down in the sewer.
Sharon Cameron:All right.
Speaker 1:She's nervous of the camera, and refuses to talk to us.
Speaker 8:Got any change?
Sharon Cameron:I don't have no money in my pocket.
Speaker 1:Just meters down the road, a newly homeless guy.
Sharon Cameron:You still homeless?
Speaker 1:There are people in need secretly.
Speaker 9:Hello Curtis. Reuben's my name.
Speaker 1:Nice to meet you. How are you?
Speaker 9:Good Curtis.
Speaker 1:So, this is home right now?
Speaker 9:Yes, this is my bed and my clothes underneath that.
Speaker 1:What put you into this situation?
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Speaker 9:I think financial reasons. Not enough money to afford all that
commodities and stuff. I think it was a financial reason. Yeah.
Speaker 1:And who's helping?
Speaker 9:Right now? I wait for public assistance and I just live on
whatever I can get out here.
Sharon Cameron:There's more of the homeless people right there.
Yeah. She always, they fight over blankets. Hey Paso. Hey, you seen
Angel?
Speaker 10:No, who are y'all? Why y'all watching me?
Sharon Cameron:I'm looking for Angel. I was looking for Angel.
Speaker 10:Angel in jail.
Sharon Cameron:Oh yeah?
Speaker 10:Yeah. Why you looking for Angel? You don't know Angel's in
jail?
Sharon Cameron:No, that's my sister.
Speaker 10:You talking about skinny Angel?
Sharon Cameron:Yeah.
Speaker 10:She in jail.
Sharon Cameron:All right. Wow.
Speaker 10:She got popped when they raided the house down the street.
Sharon Cameron:What was she doing, smoking crack?
Speaker 10:No, she bought something for undercover police officer.
Sharon Cameron:Oh God. She's gone to jail. She gone.
Speaker 1:So, not so good news?
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Sharon Cameron:No, no I don't really know how to digest that but one
thing I know for sure is that she has a second chance. Sometimes you
don't get arrested, you get rescued.
Speaker 1:Angel's story is typical. In and out of jail, on and off the streets.
And a mental illness and drug addiction to boot. But unlike Sharon, Angel
is not ready to let go of the only life she knows.
Sharon Cameron:You know, some time when you're out here, you'll take
anything just to make the pain go away.
Speaker 1:It's not a nice way to find out though, is it? From somebody
else?
Sharon Cameron:No, this is horrible. I'm hurting. Yes, I'm hurting.
Speaker 1:For 25 long years, Sharon lived on these streets. Not lived.
Existed. There are organizations striving to help people living with mental
illness. But the problem is so overwhelming, and so many people just end
up back on the street or worse, in jail. Some say, the LA County Jail is the
de facto biggest mental institution in the world. It's the evening muster at
the Union Rescue Mission. There are people with nowhere else to go. It's
scary to think how easy it is to slip off the edge in the United States. If you
lose your job, then miss a few payments on the house, there's often not a
lot standing between you and Skid Row.
This is the first intercession of the evening. They'll feed about a thousand
people tonight. First of all it's the women, and then the men, and later
they'll feed the families [inaudible 00:24:17] as well. That's a lot of mouths
to feed.
Up on the roof, it felt like a million miles away. The sun was still shining.
And it was another beautiful LA sunset. Downstairs, they were setting up
for the evening. Staff here at the Rescue Mission know they have the skills
to help people back on track.
People need to make a conscious choice to seek help. But if you have a
mental illness, that choice isn't so clear.
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What were the highlights of this week's clinical? Describe a particular patient, patient
interaction, or disease process that stood out to you
On the first day of the week, I encountered a patient with obsessive-compulsive disorder. The
patient was obsessed with the fear of being contaminated by germs and expressed fears the might
contract cancer. Normal activities such as sharing utensils with close people or touching door
handles made her very anxious and would spend even 20 minutes rinsing her hands. What stood
out most for me in this patient is to learn that one of her parents has suffered the same condition
earlier in her life. This led me to understand genetic and hereditary factors may be possible
causes of OCD.
Reflect on a situation or a patient presentation that you were unfamiliar with during
clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe
how you handled this unfamiliar situation/case.
Over the week, a patient with Somatic symptom disorder was referred to me. The patient
exhibited unfamiliar symptoms including pains and short of breath sensations. The patient
constantly worried that she would die of cancer very soon, and this caused her to appear very ill
and in deep pain. The condition as unfamiliar to me, hence I had to consult our preceptor who
later established the condition to be Somatic symptom disorder. According to Mayo Clinic
(2019) "somatic symptom disorder is characterized by an extreme focus on physical symptoms
— such as pain or fatigue — that causes major emotional distress and problems functioning."
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Describe a situation or encounter from this week that led you to a new understanding of a
specific mental health condition.
One of the interesting cases encountered this week was a patient suffering severe social phobia.
This was the first time I had encountered the condition, and this made it particularly interesting
to me. The patient's major symptoms include extreme fear of meeting of her old friends. The
patient complained about the intense fear that meetings her old friends would be humiliating
because they will judge her negatively. Interacting with this patient led me to understand that
extreme fear and anxiety leads to avoidance that ends up disrupting the individual's life. In some
instances, the condition may result in severe stress that significantly affects the patient's daily
routine, relationships, school, and other activities.
Discuss any interactions with patients that you observed, either in a therapy or a
medication management session that were missing some of the concepts you have been
learning about regarding therapeutic relationships and communication.
On the last day of the week, I interacted with two patients during the initial screening evaluation.
What made it difficult to effectively engage with these two patients was mainly my ability to
correctly interpret nonverbal behavior exhibited by the two individuals. Both patients suffered
from Somatic symptom disorder. According to Foley & Gentile (2010) "nonverbal behavior
contributes significantly to all interpersonal communication but unfortunately is often only a
peripheral area of focus in the psychotherapeutic setting."
How did you apply the content learned in your online courses to your clinical setting this
week?
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The content learned in our online courses was vital during this week. For instance, I consulted
these online materials whenever I came across an unfamiliar condition, or when caught in a
dilemma. In turn, this helped to enhance the quality and safety of patient care. In addition, these
materials helped me to minimize errors and other costly mistakes that may compromise the
safety of patient care.
Which chief complaints did you see most often this week? Provide details about how you
felt about developing your preliminary differential diagnoses lists for these patients based
on the complaints/symptoms they expressed
Depression was the most frequent mental disorder and the chief complaints included insomnia,
loss of interest, and mood swings. According to Abbot (2019), depression levels in the United
States have been rising, and have resulted in a 56 percent increase in youth suicide rates.
However, given that different patients had varying levels and severity of depression, it was a bit
difficult to develop my own preliminary differential diagnoses lists for each one of them.
Given the most frequent psychiatric disorders you encountered in your clinical rotation
this week, what is the most useful set of guidelines (i.e., depression guidelines, Beer's
criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy
I found Beer's criteria the most useful set of guidelines that I referred to for additional
information. It is important to note that Beer's criteria helps healthcare providers to differentiate
between potentially appropriate and inappropriate medications for depression patients. I found
the criteria a valuable resource particularly because it helped better my understanding of the
safety of prescribing medications for different groups of people. In the words of Lund et al.
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(2011), Beer's criteria provide a rating of severity for adverse outcomes and a descriptive
summary of the medication's associated concerns.
Thinking about the common mental health conditions you saw in your clinical this week
(see question #7), did you feel that you had adequate knowledge to discuss these diagnoses
with your preceptor? If not, what preparation work do you have planned to help you feel
more confident for the upcoming clinical week?
I don't think I possessed adequate knowledge to discuss the diagnoses with my preceptor
particularly because the majority of the patients were at different phases of depression. As a
result, it was difficult to quickly diagnose each of patient. Part of the important preparations for
improving my confidence would be reading widely and consulting my experienced peers.
List a brief plan of care for one of the patients you saw this week. Include your preceptor's
plan, too. Discuss, briefly, whether or not you agree with your preceptor's plan of care. If
not, describe what you would have done differently and why. List a brief plan of care for
one of the patients you saw this week. Include your preceptor's plan, too. Discuss, briefly,
whether or not you agree with your preceptor's plan of care. If not, describe what you
would have done differently and why.
Assessment Data Expected Outcomes Nursing
Interventions
Rationale
Insomnia, loss of
interest,
hyperventilation
Improve sleeping patterns
Overcome feelings of loss
of nervousness, tension,
Closely work
with the
patient on a
Improve the
patient’s
understanding
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rapid heart rate,
insomnia,
palpitations, and
chest pains.
and restlessness.
Eliminate palpitations,
chest pains, and sweating.
Return to the previous
level of work functioning.
one-to-one
basis.
Cognitive
restructuring
Activity
scheduling
Prescribe
medications.
Cognitive
restructuring,
cognitive
behavior
therapy
(CBT),
Exposure
therapy foe
anxiety.
of their
conditions.
Help improve
the
individual’s
understanding
of their
conditions.
Psychotherap
y help to help
identify
cognitive
distortions.
.
What situation or patient presentation did you see in your clinical setting this week that has
not yet been covered in your online psychiatric courses?
Over the week I met a patient suffering Stendhal Syndrome. The patient symptoms included
panic attacks and dissociative experiences. It was difficult to handle the case because this
particular disorder has not been covered our online psychiatric courses.
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I'm sorry to hear that you're going through a difficult time. Homelessness and mental illness are both
significant challenges that can make it hard to access basic needs like housing, food, and healthcare.
Here are some resources and tips that may be helpful:
1. Seek medical help: Mental illness is a serious condition that requires professional help. If you're
experiencing symptoms like anxiety, depression, or hallucinations, reach out to a healthcare
provider as soon as possible. They can refer you to a specialist who can provide you with the
necessary care.
2. Contact local organizations: Many communities have organizations that provide assistance to
people who are homeless or struggling with mental illness. These groups can help you find
housing, access medical care, and provide other services that may be helpful.
3. Apply for public benefits: Depending on your situation, you may be eligible for public benefits
like Medicaid, food stamps, or housing assistance. Check with your local government or social
services agency to see what programs are available to you.
4. Seek shelter: If you're homeless, seek shelter at a local homeless shelter or other housing
service provider. They can provide you with a safe place to sleep, as well as access to other
resources like food and healthcare.
5. Reach out to friends and family: If you have friends or family members who can provide support,
don't hesitate to reach out to them. They may be able to provide you with temporary housing or
other resources to help you get back on your feet.
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6. Connect with peer support: Consider connecting with peer support groups or organizations that
provide services and support for people experiencing homelessness or mental illness. Peer
support can be a valuable resource for emotional support, practical advice, and social
connections.
7. Explore employment and education opportunities: If you're able to work or study, consider
exploring employment or education opportunities. This can help you build skills, make
connections, and increase your financial stability.
8. Take advantage of free resources: Many communities offer free resources like community
meals, clothing banks, and job training programs. Don't hesitate to take advantage of these
resources if you need them.
9. Practice self-care: It's important to take care of yourself during this time. Practice self-care
activities like meditation, exercise, and spending time with loved ones. These activities can help
reduce stress and improve your mental health.
10. Stay hopeful: Remember that recovery is possible, and that things can get better. Stay hopeful
and continue to seek out the support and resources you need to move forward.
11. Address substance abuse: Substance abuse is a common issue for people experiencing
homelessness and mental illness. If you are struggling with addiction, consider seeking help from
a substance abuse treatment program. These programs can provide you with the support and
resources you need to overcome addiction and improve your overall health.
12. Utilize crisis resources: If you are experiencing a mental health crisis or feel like you are in
danger, don't hesitate to reach out to crisis resources like the National Suicide Prevention
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Lifeline or emergency services. These resources can provide you with immediate support and
help keep you safe.
13. Keep a routine: Maintaining a routine can help provide a sense of stability and control during a
challenging time. Try to establish a daily routine that includes self-care, work or school, social
connections, and other activities that are important to you.
14. Build a support network: Building a support network of friends, family, healthcare providers,
and peer support groups can provide you with a sense of belonging and help you stay motivated
during recovery.
15. Advocate for yourself: Don't be afraid to advocate for yourself and your needs. If you feel like
you're not getting the support or resources you need, speak up and ask for help. You have the
right to access healthcare, housing, and other basic needs.
Remember, recovery from homelessness and mental illness is a journey, and it's important to take it one
step at a time. Be patient with yourself, stay focused on your goals, and don't hesitate to seek out
support and resources along the way.
It's important to keep in mind that recovery from homelessness and mental illness can take time and
may require a combination of resources and support. Don't be discouraged if progress is slow, and
remember to celebrate small victories along the way. With the right support and resources, it is possible
to overcome these challenges and move forward towards a better future.
Remember, it's important to take care of yourself both physically and mentally during this time. Don't be
afraid to ask for help when you need it, and keep in mind that things can get better with time and the
right resources.
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References
Abbot, B. (2019). ‘Youth Suicide Rate Increased 56% in Decade, CDC Says." The Wall Street
Journal. Retrieved from https://www.wsj.com/articles/youth-suicide-rate-rises-56-in-
decade-cdc-says-11571284861
Foley, G. N., & Gentile, J. P. (2010). Nonverbal communication in psychotherapy. Psychiatry
(Edgmont), 7(6), 38.
Lund, B. C., Steinman, M. A., Chrischilles, E. A., & Kaboli, P. J. (2011). Beers criteria as a
proxy for inappropriate prescribing of other medications among older adults. Annals of
Pharmacotherapy, 45(11), 1363-1370.
Mayo Clinic (2019). "Somatic symptom disorder." Retrieved from
https://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/symptoms-
causes/syc-20377776
WebMD (2019)." What Is Social Anxiety Disorder?." Retrieved from
https://www.webmd.com/anxiety-panic/guide/mental-health-social-anxiety-disorder#1
