Case Study 5

Anthony, 29, is under the jurisdiction of your local provincial Mental Health Review Board on your acute care ward. He’s in breach of a disposition because of repeated alcohol and marijuana use; Anthony is also diagnosed with bipolar disorder and is currently prescribed olanzapine 10 mg and lithium 800 mg daily. He experiences mania when he uses substances, and the incident that led to his review occurred when he was under the influence (he racked up over $100,000 in property damages). He uses substances and alcohol due to the negative side effects (weight gain) from his prescribed medications. Anthony is divorced and recently obtained regular visits with his kids. He holds down a steady job in construction, but he’s worried about losing his employment because he sometimes misses shifts.

Student questions

• What is the relationship between addiction and mental illness?
• What is the relationship between the drug and alcohol use and Anthony’s diagnosis?
• What assessments would be completed?
• What medications and lab work should be done (e.g., Lithium levels)?
• In terms of Anthony’s stay on the unit, what are some safety precautions? How is a forensic general/acute unit different than a non-forensic unit?
• How does one balance custody vs. care?
• What is the legislation that pertains to Anthony’s rights?
• What is the criteria for involuntary admission in your jurisdiction?
• How do you evaluate Anthony’s capacity?
• How do you prepare for the hearing that will decide whether Anthony will continue to be committed/detained?
• What is the role of the nurse in Anthony’s case?
• And the role of the community ACT Team?
• Examine your values and beliefs: How do you balance issues of transference and countertransference?
• If you don’t support Anthony’s release, how will you maintain a therapeutic relationship or respond to him when he expresses a sense of betrayal during your day-to-day care?
• How might self-reflection help you? What are your ethical responsibilities to the Anthony and the public?

Discussion Topics

• Mental health and illness legislation
• Ethics and professional responsibilities
• Personal safety