Adult case study: Mandy (48) and Pru (89)

Background Information about the case study

Mandy Robertson, a 48 year-old, white, UK, woman, lives with her two youngest children, Jo (19) and Lucy (16), who are of mixed parentage, in a three–bedroom, ground floor flat.  Mandy’s previous partners and the fathers of the children were physically violent to Mandy and as a result these relationships ended. Neither Mandy nor her children have contact with either of these men.  Jake her son, lives nearby with his partner Ryan and visits his mother and half-sisters several times a week.

Mandy was diagnosed with Bi-polar Affective Disorder in her early 20s and 4 years ago, whilst an inpatient in the local psychiatric hospital, she met her current partner, Jim O’Neil. Mandy’s mother, Jean, lives nearby. Mandy and Jean have a difficult relationship, often clashing over Jean’s racist and homophobic attitudes.  Mandy’s father died 25 years ago and her brother Derek, died 4 years ago aged 32 from a heart condition associated with his Down’s syndrome. Mandy is close to her grandmother Pru and until recently they lived together before Pru’s Dementia meant Mandy could no longer look after her and Pru was admitted to a residential nursing home a five-mile train journey away.

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Introduction

This paper seeks to examine the above case study. It first identifies the services users (Mandy and Pru) and the specific day-to-day difficulties each of them faces, and explores the impact these difficulties have on their lives. Finally, I will try to explain the kind of support each service users require and provide critical evaluation and give reasons why they need such support followed by brief conclusion and any references I used.

Mandy

The case study raises the importance of understanding challenges and difficulties face by Mandy and providing support to her because of her mental and emotional problems, and also the need to understand the emotional vulnerability of Dementia patients such as Pru. The case study suggests that Mandy was diagnosed with Bi-polar Affective Disorder. This condition, also known as ‘manic-depressive illness’ is serious long-term condition “That affects one’s moods, which can swing from one extreme to another” (NHS, 2012). I can therefore understand how this condition can have a dramatic effect on Mandy and her two children. Studies suggest that social factors such as loss and grief are major causes of depression. Studies further suggest that ‘biological and genetic elements’ are also factors for the more severe form of mental illness such as Bi-polar Affective Disorder. (Jenkins et al., 2014: 43) Therefore, it can be difficult for her two children to distinguish between the illness and their mother’s behaviour. It is therefore, important that they are armed with information and support to help understand this condition and help their mother manage her illness. Thus, social workers need to provide Lucy and Jo with age appropriate information and support. They also need to know that Mandy’s mental health disorder is not fixed condition. Her problems can fluctuate over time, in response to a variety of stresses such as the emotional pain and bereavement she is going through.

Pru

The other server user I have chosen for my case study is Pru. Pru suffers Dementia, which is an illness that affects how human brain functions, such as memory and speech. There are different types of Dementia and therefore symptoms vary, and as the case study does not mention the type of Dementia Pru has, I cannot talked about specifics of her condition but can only generalise it. Therefore, what Pru can or cannot do depend on the type of Dementia she has. Nevertheless, Pru’s condition can not only be very distressing to her, but it can be very painful for both Mandy and her two children, whom she developed, closed relationship. Therefore, like Mandy, Pru could also develop other mental problems such as depression.

Mandy, difficulties and disadvantages

As person with Bi-polar Affective Disorder condition, Mandy can face many challenges, difficulties and disadvantages from the members of the public, their immediate family members or even social workers. This is because of the lack of knowledge and understanding of her mental illness. For example, the case studies suggested that Mandy was diagnosed with mental illness in her early 20s and previously admitted in psychiatric hospital; therefore having a mental illness could make her feel alone and isolated. And as a mother of two teenagers, she may be anxious about losing her children because of her illness, and the sense of feeling guilty for not being able to carry out her parental responsibilities can make things even harder for her. Furthermore, Bi-polar Affective Disorder condition can have serious impact on her, and she can have a difficult time caring and providing her children’s needs. Daily routines such as shopping and cooking can seem impossible. Mandy seems to ‘feel trapped in her situation. She needs an advocate to assist her in gaining access to children’s services and help her understand the mental health system’ (Glover-Wright, 2003)

Therefore, Mandy should take the lead and seek written information about the nature of her illness and should have the opportunity to make an informed decision about her well-being and the care of her children. According to the case study, Mandy’s mental illness may have been precipitated by an adjustment reaction to her relationship breakdown and the fact that her previous partners and the fathers of her children were physically violent to her. Grief is a natural response to loss and distress, thus, it is the emotional pain one feels when something or someone they love is taken away either by death for separation that needs to be addressed. Therefore, ‘the meaning of loss or change to an individual is critical in determining the nature of any grief response’ (Quinn, 2005: 2, Parker 1993)

Furthermore, Bereavement and loss are not isolated events; ‘they emerge from and interact with other life experiences’ (ibid). For example, Mandy’s father died 25 years ago and her brother Derek, died four years ago aged 32 from a heart condition associated with his Down’s syndrome. Therefore, the loss of Mandy’s loved ones may have a profound impact on her. Similarly, Mandy’s mental illness can negatively affect on her children, for example, they may not understand their mother’s behaviour, and they may even blame themselves and may take it personally and might feel very frustrated and angry about her behaviour. According to social care institute of excellence ‘an estimated one-third to two-thirds of children whose parents have mental health problems will experience difficulties themselves’ (SCIE, 2011: p,8) Young children are more ‘dependent on their parents’ reaction to grief and loss than older peers, so if Mandy shows resilience and cops well with her illness with support, Lucy and Jo may not develop serious or long lasting grief. (Cohen, Mannarino and Deblinger, 2006: 4)

Mandy Support

Pilgrim and Rogers (1999) argue that, stereotyping service users with mental health condition are common in health and social care settings because people tend to have devaluating attitudes towards mental health service users because they are seen as ‘objects of the clinical gaze of mental health professionals’. (Pligrim and Rogers, 1999) Therefore, as psychiatric patient, Mandy would value none stigmatising support and a fair access to mental health services and an appropriate person centred support from social workers, as the core values of social work practice requires that service users are seen as an individual and not an object (Basw, 2012) Thus, Social workers need to encourage Mandy to get involved in planning and delivering her mental health needs. ‘The ability to make choices about services and taking control of their lives has been highlighted by service users as being critical to their recovery’ (Barr, 2007: 319)

Another support that Mandy would most value would be, enrolling or taking part in self-help or peer support group. Mandy needs to be exposed to an environment where she feels respected and valued, and seen as an individual and not a person with mental health disorder. Research has shown joining bipolar support group’s yields ‘improvement in psychiatric symptoms and works towards the individual’s well-being and recovery’. (Barr, 2007: 319) There are benefits for joining self-help groups ‘one of the key benefits of support groups is the greater perceived empathy and respect that support groups are seen to have for the individuals they support’. (mentalhealth.org.uk, 2013)

Furthermore, if Mandy’s mental disorder is not addressed and given the support she needs, it could have negative impact on her two young children. Mandy needs support and recognition of her responsibility as a parent. Her two children’s needs must also be addressed. Researchers have highlighted the extent of the mental health problems on families. Cree (2003) suggested that children who have been ‘caring for a parent with mental disorder, might be at risk of developing mental problems themselves’ (Cree, 2003: 301-309) Adrian Falkov’s family model might be a useful when it comes to planning care package for Mandy and her children. This model is a ‘developmental and system perspective’ which is design to help in assessing parents like Mandy who are bereaved by the death of love ones and subsequently developed emotional and mental health disorders. (as quoted in Mainstone, 2014: 20) Falkov’s model examines how relations between adult mental health problems, the children and parenting issues affect each other. For example, Mandy’s mental health illness can negatively affect the development and the safety of her children. Similarly, the model shows that Mandy’s condition can also affect her parenting and her relationship with her children (Mainstone, 2014: 20,Goodman, 1999: 458-490) therefore, Mandy would value a package of care that is design to consider her, and her children as a whole when assessing their needs, as Social work practice ‘places ideas about crisis, loss, grief and bereavement within an appreciation of people’s diverse and unequal social circumstances’ (Napier, 2003: 154)

Pru, difficulties and disadvantages

In my opinion, Pru is the only service user in the case study that faces the biggest difficulties and disadvantages for the following reasons. First, like people with this condition, Pru faces widespread discrimination because of the misconception and stigma attached to Dementia. Anthea Innes (2009) comments that ‘Negative perception based on misunderstanding and stigma can lead to negative experiences, but a network of understanding and empathetic people can ease the experience of Dementia’ (Innes, 2009: 75) One of the most important disadvantages face by Pru is the pivotal role that stigma plays in defining the experience of her condition. The World Health Organization, for instance, recognize that, ‘‘stigma against older people with dementia . . . is widespread and its consequences far-reaching’’ It further, points out that stigma and misunderstanding of dementia exacerbates the pain and the grief experienced by Dementia patients (Graham et al., 2003)

Age

Second, the role of stigma plays is only minor compared to the other more challenging problems Pru is facing or could face in the future as her conditions deteriorates. Because Pru is an elderly service user, she is more at risk with age discrimination. Alison Milne (2010) agrees and argues that, ‘Dementia is a major issue amongst older people like Pru and constitutes one of the most serious challenges facing the older population’ (Milne, 2010: 227–233). The attitudes towards ageism are perpetuated in a number of ways, for example, Pru may labelled as “dirty old woman” unproductive, or demented because of her inability to communicate or inability to do demanding tasks. These labels place too much emphasis on negative side of ageing, and tend to ignore the impact of stereotyping on people like Pru who happened to be a dementia sufferer often through no fault of their own.

Pru could also face problems in health settings such as hospital and hospices, as stereotyping are often reinforced (Walsh et al., 2011) Social workers, nurses and other staff members usually decide what service user can or cannot do. For example, hospital staff determines when a patient can have food, go to bed have a bath and so on. Robert Butler (1969), the man who coined the term ageism described ageism as having three ‘distinguishable but interconnected aspects’ one of them is how institutional practices contribute to the perpetuation of stereotypes of ageism (Department of Health, 2009: 10) Crichton (1999) noted that ageism disempower the elderly and makes them vulnerable to abuse ( as cited in Walsh et al., 2011). In addistion to ageism, Pru could also face physical, psychological, and emotional abuses. But most importantly, Pru is more at risk facing human rights infringements.

Human Rights Act 1998 protects Pru against human rights violations, although obligations under the Human Rights Act 1998 are imposed mainly on public bodies. The case does not say whether the nursing home is private or public setting.

Needles to say, ‘abuse is a violation of an individual’s human and civil rights’ (SCIE, 2011: 16) and Social work ethics and values emphasise the importance of respecting the rights and needs of vulnerable service users such as Pru, it also points out the importance of good anti-oppressive practice ‘One element of anti-oppressive practice is to make sure that people’s rights are not violated. (Dalrymple and Burke, 1995: 57) The Human Rights Act 1989 is very clear regarding upholding Pru Human rights. ‘No one shall be treated in an inhuman or degrading way’ (legislation.gov.uk, 2014)

Support

There are a number of support and services that Pru would most value. First, it is vital that Pru is respected as a human being and not to be seen as a demented person. The case study suggests that Pru was admitted to residential nursing home and is in the care of social care setting. Person centred planning and direct payments and giving more choice to control of her life would have been better option for Pru. But, in the absence of these, palliative care would be the best care for her because there is lack of support available at home as Mandy could no longer looked after her. The aim of palliative care is to relieve the suffering of patients such has Pru and support them through difficult times. The World Health Organisation (2008) has defined palliative care as ‘an Approach that improve the quality of life of patients and their families facing the problems associated with life-threatening illness’ (WHO, 2014)

Respect

‘Older people, especially those living in care homes, are vulnerable to being de-humanised. (Bowes et al., 2009) As Pru is in institutional care, it is important that Pru is treated with respect and her dignity and well-being is promoted, and her views, wishes and feeling are taken into account. Similarly involving in her care is vital as she is the expert in her condition. People with dementia ‘know their condition better than anyone else’ thus, Pru’s views and experience must inform the health care services that she is using (alzheimers.org.uk, 2013) thus, facilitating such involvement would contribute to the safeguarding of her dignity and self-respect. Furthermore, Research has suggested the support that older people with dementia would value most is having ‘meaningful personal relationships’ (Bowes et al., 2009). In Pru’s case, this may be having continued contact with Mandy and most importantly with her grand children. Because of broken contact with her loved ones, Pru will have experienced loss and grief; therefore, having good contact with her family members is vital for her social well-being. (Sherman, Dacher and J, 2005) And finally assuming that a proper care plan is in place for Pru, one last thing she would value would be the right to liberty. The nursing home should care for Pru in a way that does not infringe her human rights and does not deprive her liberty. Should Pru decide to go back home even if this is seen as unwise decision, such decision must be respected and Pru should be assumed to have capacity unless otherwise proved by Approved Mental Health Practitioners. (Mental Capacity Act , 2005) The Mental Capacity Act stipulates that a person’s liberty can only be deprived in certain circumstances; for example if it is the best interest of Pru, or if such depreciation has been authorised by law. (ibid)

In conclusion, in this case study, I have selected two adults from the list given and I described the kind of disability or illness that they suffer or likely to suffer for example I have identified the mental disorder that Mandy faces and the impact this could have on herself and her two children. Similarly, I have also identified Pru’s complex problems. I have then discussed in detailed the daily disadvantages and difficulties each of them faces and the types of support they would most value, and given my reasons why they would need such support.

Word count: 2579

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