Case Study 7

You visit Melanie, 58, in her home for a post-hospital discharge visit. She is visibly lethargic and when you ask how she is feeling, she tells you she is grieving for her son who died more than a month ago. Moreover, she worries how her life choices contributed to her son’s problems. As the child of alcoholic and violent parents, she felt alone, and constantly frightened. She ran away at the age of 16, and eventually married an abusive alcoholic, who was the father of her son. She and her son escaped with police help, but at the age of 25, childhood traumas flooded her, and she began to drink and use drugs to cope. Her second husband aided her drug use, which included cocaine, prescription barbiturates and marijuana. At that point, Melanie says she had been in and out mental health hospitals for breakdowns and suicide attempts. Not only was she anorexic, but she also cut herself. Her diagnoses included rapid cycling bipolar disorder, acute anxiety and panic disorders, personality disorders, obsessive compulsive disorders and post-traumatic stress disorders and “the list goes on.” She was treated with medications and rounds of bilateral shock treatments that she says she never wanted. “The worst part was being labeled an alcoholic and drug addict,” she adds, which diminished her true needs. She tells you that she has been alcohol and drug free for over 10 years thanks to meeting her third husband who is very supportive. And that she has had therapy to assist with her past traumas. But none of it was enough to help her help her son who died of an accidental drug overdose caused by a lethal combination of opioids mixed with the newly prescribed high powered psychiatric drugs.

Student questions

• What are you next steps with Melanie?
• How do you assess her risk for re-lapse?
• What kinds of support strategies can you provide?

Discussion Topics

• Recurring trauma and its influence pre-existing mental health illness and substance use disorders
• Community supports necessary to ensure ongoing mental health and wellness for clients with diagnoses