Mental Health Diagnosis in Social Work: The Case of Miranda

Discussion: Assessment of Depression Although there has recently been a deluge of media highlighting various prescription drugs for treatment of depression and anxiety, there remains a lack of understanding about mental health, in general. Further, stigma often is attached to seeking professional help for mental health issues. Depression is a disorder that people often do not realize they are experiencing. The symptoms of depression can vary from person to person (i.e., weight gain vs. weight loss, loss of sleep vs. increased sleep), which can also make it difficult to diagnose. Many people experience times of sadness, including waking up feeling down for no apparent reason. These feelings are not unusual and come with the ups and downs of life. As a professional, understanding the criteria for depression and comorbid diseases is part of a comprehensive assessment. Depression and anxiety can precede other mental health and physical issues and can also be a result of those issues. Clarifying the progression of the presenting problem will enable you to establish a well-informed treatment plan and intervention.

For this Discussion, review the course-specific case study for Miranda in this week’s resources. As you review and analyze this case, remind yourself of the need for a comprehensive assessment that does not focus on the perceived deficits. You will read and then consider the responses of the professionals involved in the case. While reviewing their varied responses, consider their possible biases and how they have chosen to focus on the presenting problem and the client’s situation.

Post the depression scale you located, summarize how it is used, and describe the target population. Describe how you might apply this assessment to the course-specific case study of Miranda and include any additional questions you would ask Miranda to assess her level of depression. Then, identify the red flags that might cause concern and/or indicate significant depression. Finally, identify a scale that can be used to assess risk for suicide.

Support your posts with specific references to the Learning Resources. Be sure to provide full APA citations for your references.

PRACTICE

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Mental Health Diagnosis in Social Work: The Case of Miranda

Miranda is a 35-year-old, Scottish female who sought counseling for increased feelings of depression and anxiety. Her symptoms include constant worry, difficulty sleeping, irritability, increased appetite, unexplained episodes of panic, feelings of guilt and worthlessness, and feelings of low self-esteem. She denied any suicidal/homicidal ideation but verbalized feelings of wanting to be dead. She maintained these thoughts were fleeting and inconsis- tent. She reported an increase in alcohol consumption, although clarified it was only when she felt anxious. She denied any black- outs or reckless/illegal behavior while drinking. She denied any other drug use.

Miranda works in the fashion industry and reported that she is very well liked by her peers and clientele. She is regularly chosen to train other staff members and comanage the store. However, she is often given a heavier workload to compensate for coworkers who are unable to perform at the expected level of her employer. Miranda stated that she has trouble saying no and feels increas- ingly irritable and frustrated with her increased workload.

Miranda has been married to her husband for 3 years, and they have no children. She reported that both her mother and father have a history of mental illness. Miranda’s parents are divorced, and when they separated, Miranda chose to live with her mother. Miranda’s mother remarried a man she described as “vicious and verbally abusive.” Miranda stated that her stepfather called her names and told her that she was worthless. She said he made her believe that she was sick with chronic health issues and many times forced her to take medicine that was either unnecessary or not prescribed by a doctor. Eventually he asked Miranda to leave her mother’s home. Miranda stated that her mother was well aware of her stepfather’s behavior but chose not to intervene, stating, “He is a sick man. Just do what he says.” She denied any physical or sexual abuse in the home.

SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR

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In order to treat Miranda’s symptoms, we first addressed the need for medication, and I provided a referral to a psychiatrist. The psychiatrist diagnosed her with panic disorder and major depres- sive disorder and prescribed appropriate medications to assist her with her symptoms. Miranda and I began weekly sessions to focus on managing her boundaries both at work and with her family. We discussed her behavior around boundary setting as well as the possibility of enlisting her husband as a support person to encourage and promote healthy boundaries. We also discussed unresolved issues from her childhood. This approach enabled Miranda to gain insight into the self and how her maltreatment as a child affected her functioning in the present time. This insight enabled Miranda to validate her feelings of anger, frustration, and sadness about her upbringing and further give herself permis- sion to set appropriate boundaries in her relationships. We also discussed the need for relaxation and stress management. Miranda was able to identify that she used to enjoy cycling and running but had not been engaging in them because of the demands at work. After discussing the importance of self-care, Miranda began to exercise again and set a goal to enter local running and cycling events to encourage herself to continue.

After 1 year of therapy, Miranda decided to taper down her medication, which was monitored by her psychiatrist. She has chosen to remain in therapy weekly to monitor her mood as she decreases her medication. Miranda’s overall presentation has improved greatly. With the use of medication, behavioral therapy, relaxation techniques, and psychodynamic therapy, Miranda’s affect presents as stable and her symptoms of depression are gone. Miranda is a client that is able to verbalize the benefits of treatment in helping her gain insight and empower herself to vali- date her own emotional needs. She has been a highly motivated patient who enjoys the safety of being able to express her thoughts and feelings without judgment.

APPENDIX

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Reflection Questions The social worker in each of the cases answered select additional questions as follows.

Practice

Mental Health Diagnosis in Social Work: The Case of Miranda

1. What specific intervention strategies (skills, knowledge, etc.)did you use to address this client situation? I referred the client to a psychiatrist. I used behavioral therapy,

2. Which theory or theories did you use to guide your practice? I used psychodynamic and structural family theories to address

3. What were the identified strengths of the client(s)? Miranda was motivated, identified goals well, and had a supportive husband.

4. What were the identified challenges faced by the client(s)? Miranda reported a mental health history. 5. What were the agreed-upon goals to be met to address the concern?

5. How can evidence-based practice be integrated into this situation?

SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR 96

1. Is there any additional information that is important to the case?

2. Describe any additional personal reflections about this case. Miranda’s case is a great example of the need for a thorough mental health history, mental status exam, as well as family history of mental health issues and relationships.

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