Community Mental Health Patient Review

REVIEW / MANAGEMENT

-- Summary of Treatment Provided Since Last Review --

[checkbox value="clinical case management|mental state monitoring|psychoeducation|family support|CMO referral|CMO support|psychiatric medication|psychosocial supports|supported accomodation|sheltered employment|a CTO|psychotherapy|counselling|DBT|CBT-E|peer support|risk management and planning|occassional ACS contact and monitoring|NDIS support|an inpatient admission|rehabilitation services|suicide prevention services"] [textarea default=""].

-- Date / Time of Review --

Date: [text default="DATE"]
Time: [text default="Time"]

-- Issues / Problems Identified at Assessment --

My assessment also revealed difficulties with: 

[checkbox value="symptom severity|intrusive thoughts|physical illness|bereavement|family health difficulties|adjusting to stage of life|substance withdrawal|upheaval of lifestyle|substance misuse|divorce|separation from partner|relationship problems|imprisonment|poverty|personal injury|marital discord|dismissal from work|marital reconciliation|retirement|change in health of a family member|pregnancy|sexual difficulties|gain a new family member|business readjustment|change in financial status|arguments with others|mortgage|debt|work stress|child leaving home|trouble with in-laws|lack of achievement|partner's employment status|school starting|school ending|change in living conditions|revision of personal habits|trouble with the boss|trouble with parents|change in work hours|change in work conditions|education pressure|change in residence|change in school|church|religion|change in social activities|addictions|money worries|change in sleep habits|change in family structure|change in eating habits|vacation|holiday stress|legal problems|problems with the weather|academic underachievement|target of bullying|discord with teachers|stressful work schedule|under-employment|hazardous work conditions|exposure to toxins|inadequate housing|homelessness|discord with lodgers|discord with neighbours|discord with landlord|insufficient welfare support|low self-esteem|physical abuse|sexual abuse|emotional abuse|a traumatic experience|parental pressure|unusual parenting practices|discord with healthcare professional|legal problems|victim of crime|immigrant status|minority status|marginalization|social withdrawal and isolation|unable to make friends"][textarea cols=80 rows=10 default=""].

-- Reason for Referral --

[textarea cols=20 rows=1 default="This patient"] was referred to Community Mental Health for:

- assessment
- treatment
- symptom monitoring
- care-planning
- advocacy
- linking with rehabilitation and community support services

-- Other Issues / Problems --

Current factors impacting on recovery include: 

[checkbox value="low motivation to change|denial of the mental health diagnosis|personality factors|poor coping skills|poor rapport with our service|unrealistic expectations for recovery|lack of community based services|difficulty coping with symptoms|unpleasant side effects from medication|poor compliance with medication|missing scheduled appointments|avoiding service contact|not hopefully about the future|unwilling to play an active role in recovery|identifies with the sick role|impulse control difficulties|does not derive benefit from their treatment|social isolation|lack of family support|continual substance abuse|feels stigmatized|engages in splitting behaviours|is hostile towards our service|has a shy and inhibited temperament|poor cohesion between services supporting patient|co-morbid medical problems|has a history of childhood adversity|co-morbid mental health concerns|intellectual difficulties|secondary gains from illness|poor rapport with the case manager"] [textarea cols=80 rows=5 default=""]

-- Summary of Progress --

At our last contact I would rate the severity of [text default="the patient's"] illness as [select value="stable and without symptoms|fully recovered|mildly ill|moderately ill|severely ill|among the most extremely ill patients"].
Compared to their condition on admission, I rate [text default="the patient's"] progress as: [select value="very much improved|much improved|minimally improved|no change|minimally worse|much worse|very much worse|unable to be assessed"].

-- Consumer View of Progress --

When asked to rate clinical progress, [text default="the patient"] reported [select value="very much improved|much improved|minimally improved|no change|minimally worse|much worse|very much worse|they don't know"]. 

-- Reason for Review --

[select value="Change in clinical status|Routine 13-Week Review|Change in Patient's risk status"]

MEDICATIONS: [textarea cols=50 rows=1 default="Medication"]

ASSESSMENT OF RISKS:

[checkbox name="suic" value="-- Suicide Risk Assessment --"][conditional field="suic" condition="(suic).is('-- Suicide Risk Assessment --')"] 

The Pts suicide risk status is: [checkbox value="higher than|the same as"] the general population. 

Enduring factors of concern: [checkbox value="nothing of note|Hx of denying the need for service contact|Hx of avoiding of service contact|non-responsiveness to pharmacological treatment|non-responsiveness to psychosocial interventions|personality structure|Hx of substance abuse|recent discharge from a psychiatric facility|chronic stressors|a history of self-harm|a history of previous suicide attempts|previous hospitalization for suicidality|previous hospitalization for self-harm|Hx of psychiatric illness|unstable personality structure|a background of childhood adversity|having a family history of suicide|divorced|demographic - male - single age 35-64|problem-solving difficulties|Hx of impulsive behaviour|history of significant personal loss|Hx of reckless and self-endangering behaviors|absolutistic thinking|tunnel vision|limited capacity for self soothing|perfectionistic traits|struggles with sexual orientation|guns in the home|Pt is guarded around the issue of risk|access to abundant medications|chronic medical illness|chronic pain"]. 

However, its worth noting the following strengths that offer suicide risk protection: [checkbox value="treatment responsiveness|connectedness to individuals, family, community, and social institutions|problem-solving skills|coping skills|ability to adapt to change|a sense of purpose or meaning in life|personal beliefs that discourage self-injury|good social skills|ability to manage feelings of anger|good health|access to mental and physical health care|healthy fear of risky behaviours and pain|hope for the future and optimism|sobriety|medical compliance|a sense of the importance of health and wellness|impulse control|a strong sense of self-worth or self-esteem|a sense of personal control or determination|access to a variety of clinical interventions|help seeking behaviours|resiliency|expressed reasons for living|being married|being a parent|strong relationships|supportive friends|supportive family members|supportive spouse|opportunities to participate in and contribute to school or community projects and activities|living in a reasonably safe and stable environment|having restricted access to lethal means|sense of responsibility and duty to others|being a pet owner"] [textarea default=""].

The Pts suicide risk state is currently [checkbox value="elevated|at baseline"]. 

Factors affecting the Pts risk state include: [checkbox value="nothing of note|untreated mental illness|suicidal thinking|homelessness|personality disorder Sx|current stressors|lack of distress tolerance skills|lack of therapeutic alliance|access to lethal means|feels abandonned|feels socially undesirable|withdrawal from support groups|relationship breakdown|isolating and withdrawing from others|treatment non-compliance|abuse of substances|psycho-social stressors|feelings of hopelessness|feelings of anger|lack of vocational skills|unmet needs|external locus of control|rejection from peer group|recent loss of status|recent loss of ambitions|current suicidal plan|plan lethality|preparation behaviours|vocalising threat to suicide|rehearsal behaviours|recent suicide attempt|regrets not dying|acute mood disorder|increased substance abuse|mood lability|suicide command hallucinations|insomnia|persistent nightmares|unremitting pain|persistent distress|persistent agitation|tearfulness|guarded and difficult to assess|withdrawal from services|comorbid MH concerns|feelings of hopelessness|severe anhedonia|severe depression|loss of self-esteem|feelings of shame|feeling intolerably alone|feeling trapped|no reasons for living|loss of purpose and meaning|increased impulsivity|increased recklessness|increased anger|seeking revenge|recent violent behaviours|final act behaviours|stalking|intense jealousy over ex|recent loss of relationship|loss of social support|recent discharge from MH-IPU|loss of job|increasing financial pressure|loss of status|recent suicide of a loved one|declining health|pending legal issues|pending criminal charges|feeling victimised"] [textarea default=""].

Available support resources include: [textarea default="Mental Health Line 1800011511, The ACS 66202323, Case Manager during business hours 66202300, Beyond Blue 1300224636, Lifeline 131114, Mensline 1300789978, Kids Helpline 1800551800, QLife 1800184527, Suicide Callback Service 1300659467, Safehaven - 60 Uralba Street, Veterans 1800011046, Rekindling the Spirit - 25 Uralba street 66225534, presenting to the ED after hours"]

Foreseeable risk changes of concern include: [textarea default=""][/conditional]

Self-harm: [textarea cols=50 rows=1 default="No foreseeable risks apparent from our last contact, and no historical risks reported"]

Violence: [textarea cols=50 rows=1 default="No foreseeable risks apparent from our last contact, and no historical risks reported"]

Vulnerability:[textarea cols=50 rows=1 default="No foreseeable risks apparent from our last contact, and no historical risks reported"]

Harm to U18s: [textarea cols=50 rows=1 default="No foreseeable risks apparent from our last contact, and no historical risks reported"] 

Absconding: [textarea cols=50 rows=1 default="No foreseeable risks apparent from our last contact, and no historical risks reported"]

Other risks: [textarea cols=50 rows=1 default="No foreseeable risks apparent from our last contact, and no historical risks reported"]

IMPRESSION AND PLAN

-- Formulation --

[text default="Name"] is a [text default="X year old"] [select value="female|male"] [select value="voluntary|involuntary"] Patient, presenting with: [checkbox value="acute mental health distress|multiple complex psychosocial issues|a developmental disorder|schizophrenia spectrum disorder|situational crisis|thoughts of suicide|thoughts of harm to others|thoughts of self-harm|NSSI|superficial self-harm|serious self-harm behaviours|bipolar disorder|depressive disorder|anxiety disorder|OCD|a trauma and stress related disorder|a dissociative disorder|a somatic symptom disorder|a feeding and eating related disorder|an elimination related disorder|a sleep-wake disorder|sexual dysfunction|gender dysphoria|impulse control related disorder|substance related disorder|a neurocognitive disorder|a personality disorder"] [textarea default=""], which, at the time of their referral, was characterised by these symptoms: [checkbox value="fear and worry|panic|behavioural avoidance|clinging and neediness|pacing|anxiety|irritability|low mood|sadness|inner emptiness|anhedonia|poor concentration|disturbed sleep cycle|guilt|low self-worth|hopelessness|thoughts of suicide|parasuicidal behaviours|suicidal behaviours|deliberate self-injury|disturbed sleep|dissociation|provocative behaviours|compulsions|domineering others|eccentricities|emotional detachment|negativism|denial|projection|splitting|passivity|loss of appetite|increase in appetite|lethargy|euphoria|excessive energy|talkativeness|racing thoughts|grandiosity|impulsivity|insomnia|decreased need for sleep|flashbacks|nightmares|intrusive thoughts|heightened threat sensitivity|perceptual disturbance|disorganised thinking|disorganised behaviours|agitation|cognitive difficulties|speech difficulties|hallucinations|delusions|vulnerabilty to exploitation|social withdrawal|amotivation|impaired reality-testing|unhealthy weight loss|unhealthy weight gain|medical problems associated with low BMI|body dysmorphia|alexithymia|medical problems associated with high BMI|family discord|purging|unhealthy weight loss techniques|preoccupation with food|over-valued body ideals|inattention|distractibility|hyperactivity|intellectual difficulties|social difficulties|obsessions|unhealthy preoccupations|cognitive inflexibility|poor social reciprocity|language difficulties|insightlessness|treatment refusal|poor medication adherence|legal difficulties|debts|reputational damage|housing difficulties|unemployment|poverty|unhealthy lifestyle choices|financial stress|oppositional behaviours|hostility towards treatment and support services in general|substance misuse|medication misuse"] [textarea default=""].
 
The current treatment includes: [checkbox value="clinical case management|mental state monitoring|psychoeducation|family support|a CMO referral|psychiatric medication|psychosocial supports|supported accomodation|sheltered employment|a CTO|psychotherapy|counselling|DBT|CBT-E|peer support|risk management and planning|occassional ACS contact and monitoring|NDIS support|an inpatient admission|rehabilitation services"] [textarea default=""].  

Factors impacting on recovery include: 

[checkbox value="low motivation to change|denial of the mental health diagnosis|personality factors|poor coping skills|poor rapport with our service|unrealistic expectations for recovery|lack of community based services|difficulty coping with symptoms|unpleasant side effects from medication|poor compliance with medication|missing scheduled appointments|avoiding service contact|not hopefully about the future|unwilling to play an active role in recovery|identifies with the sick role|impulse control difficulties|does not derive benefit from their treatment|social isolation|lack of family support|continual substance abuse|feels stigmatized|engages in splitting behaviours|is hostile towards our service|has a shy and inhibited temperament|poor cohesion between services supporting patient|co-morbid medical problems|has a history of childhood adversity|co-morbid mental health concerns|intellectual difficulties|secondary gains from illness|poor rapport with the case manager"] [textarea cols=80 rows=5 default=""]  [textarea cols=80 rows=1 default=""].

Factors promoting recovery include: [checkbox value="good adjustment and coping skills|good cognitive reappraisal skills|acceptance of the illness as real|good understanding of the impact of illness|good response to medications|minimal side effects of medications|strong self-concept|ability to self-reflect|ability to take ownership of recovery|a sense of agency|internal locus of control|exploits strengths|is hopeful for future|desiring change|takes responsibility for health habits|uses occupation and distraction in managing symptoms|good social supports|close relationships|has a sense of belonging|values friends and peers|has family support|has cultural attitudes promoting recovery|feels cared for|is realistic|maintains a sense of meaning in life|symptoms are manageable|is psychologically minded|good rapport with case manager|well engaged with support services|attends social events"]

Recovery progress to date has been [select value="good|fair|static|minimal"]

-- Diagnosis --

[textarea cols=50 rows=1 default="Diagnosis"]

-- Action Plan Following The Review --

[textarea cols=70 rows=20 default="Continue with current treatment"]

-- Clinicians Involved In The Review --

[textarea default=""]