Case Study 3

Thomas, a 16-year-old high school student, visits you during class in distress. He tells you that he’s being bullied at school because the kids think he is gay. Thomas tells you he thinks he might be transexual, but that he is scared to tell anyone, and voices suicide ideation. He is not supported at home: his mother and father, both professionals, work long hours and his older sister picks on him. Thomas’s best friend since the age of 10 recently told him he didn’t want to hang out with him anymore because he was “weird.” A few months ago another friend who was picked on more than Thomas went missing. Rumour in the school indicates that he ended his life.

Student questions:

• What are your next steps with Thomas?
• Do you have any immediate con-cerns in terms of Thomas’s safety?
• How do you conduct a Mental Status Exam?
• Howdo you conduct a suicide risk assessment?
• Is a crisis intervention required?
• What kinds of community-based support strategies would you recommend?
• Do you approach Thomas’s family? If so, how?
• What your role in terms of mental health advocacy and promotion?
• How does organizational culture influence the current provision of mental health care for students; how might that culture impact any changes you propose?
• What kinds of strategies can you develop?
• Who might be on an inter and intra-professional team?
• What kinds of stakeholders are available to assist with policy or program development?

Educator elaboration

• As school nurse, you want to prevent incidences of bullying and address the systemic issues related to student mental health.

Discussion Topics

• The impact of bullying on youth
• Diversity as it related to mental health
• Sexuality and its impact on mental health, (e.g., sexuality is not an illness)
• Stigma and its impact on mental health
• Developmental psychology/child and youth
• Family-centred-care