slide discussion

Scenario 1

Aaron Abraham 32 is a black Muslim (practicing) man originally from Eritrea, English is not his first language however he is fluent. His new job has relocated him to the locality, it is physical work and involves shift work. He has no extended family or friends in the area.

Aaron has 2 school age children; one child has a blood disorder that requires weekly attendance at hospital which is 19 miles away.

Aarons wife does not work, she rarely speaks to anyone and only goes out with her husband.

Aaron has an acquired blood disorder and there is an ongoing legal challenge in regard to this. He requires regular appointments in hospital, it has affected his physical condition, his quality of life and his mental wellbeing.

Aaron attends the Gp and tells her that he is suffering from depression and that he wishes to be prescribed anti-depressant medication. The doctor declines, saying that this medication can have bad side effects and can create dependency. The Gp also maintains they are a costly resource, like most drugs and that he already receives expensive NHS input due to his blood condition. She maintains that anti-depressants should not be used until all other options have been tried. She asks Aaron if his depression is the result of life events and suggests he might benefit from counselling, or even just to take the time to work through what has been happening for him.

Aaron maintains he is not obliged to discuss his personal life, having looked into the matter himself, he tells her he is informed and has researched depression and its treatments on the internet. He feels he has reached a decision about what he needs and that his decision should be respected, rather than the doctor impose her own views.

Scenario 2

Aled is a 48 year old man. He has been a prison officer for 20 years.

He is married with a 3-year-old son.

Aled reports playing an active role in his sons’ life, however more recently he has experienced a high level of stress at work and is finding it increasingly difficult to concentrate, having little enthusiasm for anything. Aled has previously presented to his Gp with sleep problems and was prescribed medication which he has continued to take on a long-term basis. Aled has been self-medicating with drugs ( cannabis , benzodiazepines) bought from other sources.

Aled has developed symptoms of anxiety inducing palpitations, headaches and nausea, this coupled with symptoms of depression, tearfulness and lethargy. He admits to feeling ‘very bleak’ about his future and is trapped in a negative thought cycle which means he catastrophizes and personalises most situations. He feels that he has brought these problems upon himself by being what he describes as ‘weak willed’ and feels unable to spend time with his son, thinking that this in turn is a burden upon his wife.

Aled has recently begun drinking heavily and increased his intake of illicit substances, he has experienced disorientation and tactile hallucinations.

During a recent call to his mother-in-law, he talked about ending his life. Aled has been assessed by an Approved Mental Health Practitioner who concluded that he was experiencing an acute stress reaction coupled with severe symptoms of depression and it is likely that his drug use has caused symptoms akin to psychosis . Aled is reluctant to engage in community interventions as he believes this will confirm he is mentally ‘unstable’ and incapable of returning to work.

Scenario 3

Mr Charles Rees is a white man from a coal mining community in South Wales. He is 84 years old and lives with his wife Margaret (also white aged 79), she is his main carer. They have two daughters who are infrequent visitors. They have several grandchildren one of whom has Lasting Power of Attorney for Finances and Health and Welfare.

Mr Rees has a diagnosis of Parkinsons, whilst not extraordinary given his age, his memory appears to be declining. He is physically frail and has had a number of particularly nasty falls.

In respect of his Parkinson’s symptoms his tremor is more pronounced. Bradykinesia and dysphagia cause him a great deal of emotional distress. Mr Rees has recently become quite disinhibited.

Mrs Rees, his wife, has described their relationship as ‘unhappy’. She resents having to care for him and indicates that the stress of it is taking a toll on her own health.

Mrs Rees tells you that during the day she prefers to be out of the house and maintains that before she leaves she makes sure there is food for a snack ‘if he wants one’ she makes sure her husband is ‘safe’. Due to her husbands ‘inabilities’ she locks him in, she says that ‘even if he wanted to’ he is unable to navigate the lock. The family use their ‘Alexa App’ to communicate with Mr Rees throughout the day and there is a camera installed in the living area that monitors his movements.

Although you have not witnessed this, you have a strong suspicion that Mrs Rees may be taking her frustration out on Mr Rees himself. He appears frightened of her presence, he sometimes flinches when she comes near him and, though he makes no complaint s about her, he is very anxious to move to a residential care.

Mr Rees had built a successful business which, when diagnosed with Parkinsons was handed to his long standing friend and partner. His partner has always managed his personal finances and the day to day running of the company.

The family have no contact with services other than the Parkinsons consultant.

2023-24