Understanding the MSE - Lisa (w/- commentary)

Summary

Lisa, a regular cannabis and occasional speed user, has been attending counseling sessions with Jenny for six months. Recently, she has been experiencing paranoia, believing she is being watched by cameras and hearing voices that criticize her and warn her about her boyfriend, Jonno. Lisa has been sleeping in a garden shed with a knife for protection and has stopped taking her antipsychotic medication. Concerned about her mental health, Jenny arranges an appointment with the mental health service for further assessment.

Takeaways

• 🌿 Lisa is a regular cannabis and occasional speed user who has been seeing a counselor for the past six months.
• 🏥 Lisa was admitted to a psychiatric hospital last year and was discharged with antipsychotic medication.
• 👥 She has recently moved out of her parents' home to live with her boyfriend, Jonno.
• 🔍 Lisa's counselor noticed she appeared restless, agitated, and was responding to unseen stimuli, indicating a possible mental health relapse.
• 🏠 Lisa believes there are cameras in her house watching her, leading her to sleep in the garden shed to avoid being watched.
• 🗣️ She hears voices that tell her she is worthless and that she needs to be cautious of Jonno, who she thinks might harm her.
• 🔪 Lisa has been sleeping with a knife to protect herself, showing signs of paranoia and delusions.
• 💊 Lisa has misplaced her medication and hasn't been taking it, which could be contributing to her current mental state.
• 🚫 There is a breakdown in communication with her parents, who are upset about her moving in with Jonno.
• 🤔 The counselor is concerned about Lisa's mental health and arranges for her to see a mental health worker for further assessment.

Q & A

How long has Lisa been seeing Jenny, the counselor?

Lisa has been seeing Jenny, the counselor, for the last 6 months.

What was the reason for Lisa's first admission to a psychiatric hospital?

Lisa's first admission to a psychiatric hospital was due to her mental health issues, and she was discharged with antipsychotic medication.

What substances does Lisa regularly use?

Lisa is a regular cannabis user and an occasional speed (amphetamine) user.

Why has Lisa moved away from her parents?

Lisa has recently moved away from her parents to live with her boyfriend, Jonno.

Why is Lisa unable to stay in the house according to the transcript?

Lisa believes there are cameras in the house that are watching her, which makes her feel unsafe and compels her to stay outside.

Where does Lisa sleep when she is not able to be in the house?

When Lisa feels she cannot be in the house, she sleeps in the garden shed.

What does Lisa believe about the cameras and voices she experiences?

Lisa believes the cameras are on the roof and in every room, watching her, and she hears voices that are telling her horrible things and that she needs to protect herself from Jonno, her boyfriend.

What does Lisa think Jonno has done to her according to the voices she hears?

The voices Lisa hears tell her that Jonno has put a transmitter in her stomach, and everyone knows what she is thinking all the time.

How does Lisa plan to protect herself from Jonno as per the voices' suggestions?

Lisa has been sleeping with a knife to protect herself from Jonno, as suggested by the voices she hears.

What is the current status of Lisa's medication?

Lisa has misplaced her medication and cannot remember the last time she took it, indicating she might not have been taking it for a while.

What action does the counselor, Jenny, take regarding Lisa's mental health?

Jenny, the counselor, decides to connect Lisa with her mental health worker and sets up an appointment for further assessment, given Lisa's symptoms and her non-adherence to medication.

Outlines

00:00

🌿 Lisa's Struggles with Paranoia and Delusions

Lisa, a regular cannabis and occasional speed user, has been attending counseling sessions with Jenny for six months. She was previously admitted to a psychiatric hospital and was discharged on antipsychotic medication. Recently, Lisa has been experiencing paranoia, believing she is being watched by cameras in her house and hearing voices that are critical and threatening. These delusions have led her to sleep in the garden shed with a knife for protection, fearing for her safety. Her counselor, Jenny, notices Lisa's unusual appearance and restlessness during the session, indicating a potential relapse or worsening of her mental health.

05:01

🗣️ Delving into Lisa's Fears and Drug Use

In this session, Lisa expresses her fear of being inside her house due to the perceived surveillance and her belief that her boyfriend, Jonno, may harm her. She is sleeping with a knife as a means of self-protection. The counselor, Jenny, conducts a risk assessment and learns that Lisa's drug use has increased, particularly her use of speed. Additionally, Lisa has misplaced her medication, which raises concerns about her mental health stability. Jenny suggests involving Lisa's mental health worker to better understand and address her current situation.

10:03

🏥 Mental Health Assessment and Support

The final paragraph details the outcome of Lisa's session with Jenny. Despite her anxiety and agitation, Lisa demonstrates insight into her condition, acknowledging the possibility of a mental health relapse. She agrees to further assessment by the Mental Health Service. Jenny arranges an appointment for Lisa, ensuring she has a support system in place. The assessment notes Lisa's normal speech and language but also her difficulty in concentration and memory, which are concerning signs. The summary highlights Lisa's willingness to engage with mental health services and the importance of ongoing support.

Keywords

💡Psychiatric Hospital

A psychiatric hospital is a specialized facility that provides treatment and care for individuals with mental health disorders. In the video, Lisa had a first admission to a psychiatric hospital last year, indicating that she has a history of mental health issues that required professional care and management.

💡Antipsychotic Medication

Antipsychotic medications are drugs used to treat psychotic disorders by altering the levels of certain chemicals in the brain. Lisa was discharged with antipsychotic medication, suggesting that her condition might involve symptoms like hallucinations or delusions, which are commonly managed with such drugs.

💡Cannabis

Cannabis, also known as marijuana, is a psychoactive drug derived from the Cannabis plant. Lisa is described as a regular cannabis user, which could potentially exacerbate her mental health symptoms or complicate her treatment, as cannabis use can have psychoactive effects that interfere with mental stability.

💡Speed

Speed is a slang term for amphetamines, a class of stimulant drugs that increase alertness, attention, and energy. Lisa's occasional use of speed is mentioned, and her recent increase in use could indicate a relapse into substance abuse, which might worsen her mental health or be a coping mechanism for her symptoms.

💡Paranoid and Delusional Thinking

Paranoid thinking involves irrational suspicion and mistrust of others, while delusional thinking involves fixed false beliefs. Lisa exhibits signs of these thought patterns by believing she is being watched by cameras and hearing voices that tell her to protect herself, indicating a possible exacerbation of her mental health condition.

💡Voices

Hearing voices, or auditory hallucinations, is a symptom of certain mental health disorders, particularly psychotic conditions. In the script, Lisa hears voices that tell her she is not good and that she needs to protect herself from her boyfriend, which is a key indicator of her mental distress.

💡Risk Assessment

A risk assessment is a process of evaluating the likelihood of a particular risk occurring and determining the appropriate response. The counselor decides to conduct a full risk assessment with Lisa, indicating that there are concerns for her safety and well-being, particularly given her delusions and the potential for self-harm or harm to others.

💡Mental Health Worker

A mental health worker is a professional who provides support and treatment for individuals with mental health conditions. The counselor suggests connecting with Lisa's mental health worker to better understand her situation and provide appropriate care, highlighting the importance of a collaborative approach to mental health treatment.

💡Medication Non-Adherence

Medication non-adherence refers to a patient not taking their prescribed medication as directed. Lisa has misplaced her medication and cannot remember the last time she took it, which could lead to a relapse or worsening of her symptoms, as maintaining medication regimens is crucial for managing mental health conditions.

💡Mental Illness Recurrence

The recurrence of mental illness refers to the re-emergence of symptoms after a period of remission. The counselor expresses concern that Lisa might be getting unwell again, as her current experiences with voices and delusions could indicate a return of her mental health issues.

💡Insight and Judgment

Insight refers to a person's awareness of their mental state, while judgment involves the ability to make sound decisions. Lisa shows insight by considering that her experiences might be due to a reoccurrence of her mental illness, and she demonstrates judgment by agreeing to contact the Mental Health Service for further assessment.

Highlights

Lisa has been attending counseling sessions for the past six months.

Lisa was discharged from a psychiatric hospital with a prescription for antipsychotic medication.

Lisa is a regular cannabis user and occasionally uses speed.

She has recently moved out of her parents' home to live with her boyfriend, Jonno.

Lisa appears restless and agitated during the counseling session.

Lisa is experiencing paranoia, believing she is being watched by cameras in her house.

She has been sleeping in a garden shed to avoid the cameras, finding it uncomfortable.

Lisa hears voices that are negative and instruct her to protect herself.

The voices suggest that Jonno may have put a transmitter in her stomach.

Lisa is considering using a knife to protect herself from Jonno.

Lisa has been using speed again, possibly twice a week for the past two weeks.

She has misplaced her medication and cannot remember when she last took it.

Lisa has had a falling out with her parents since moving out.

The counselor expresses concern that Lisa might be experiencing a relapse of her mental illness.

Lisa agrees to contact her mental health worker for further assessment.

The counselor arranges an appointment with the mental health service for Lisa.

Lisa shows insight, acknowledging that her experiences could be due to a reoccurrence of her mental illness.

Transcripts

Lisa has been seeing Jenny a counselor

in the local drug service for the last 6

months she had a first admission to a

psychiatric hospital last year and was

discharged an antis psychotic medication

Lisa is a regular cannabis user an

occasional speed user she has recently

moved away from her parents to live with

her boyfriend jonno oh hello Lisa it's

good to see you again do come on through

Lisa I notic that you're not looking

your usual self usually you look so

smart Lisa's counselor noted that she's

not looking her usual self that normally

she looks quite

smart so how are things going for

you it's it's okay um yeah I don't know

I don't know

um yeah I'm a little bit worried

actually okay so what's been

happening um I haven't really been able

to be in the house all the time lately

cuz there's cameras in there oh okay

okay so what have you been doing if you

aren't able to be in the house where

have you

been yeah I can't I I have to outside

because the cameras are watching me so

and has that been a lot of the time at

night time and when it's at night at

night time I I sleep out in the garden

shed well that possibly would be rather

uncomfortable I would imagine it's that

hard for you yeah I don't like it it's

cold and

dark Lisa appeared restless and agitated

she was continually fidgeting in her

chair at times she was distracted and

was seen to be responding to unseen

stimuli in the waiting

room so do you feel safe in the garden

shed not really but I've got no other

choice I I've I've tried to protect

myself the best way I can okay okay so

you think that you're protecting

yourself by being in the garden shed

yeah I just want to ask you a little bit

about these cameras you said that you

had cameras and they were watching you

in the house yeah they're they up on the

roof and they're in every single room

and they're they're I don't know what

they're what they're doing there but

they're watching me and I

can I start I can hear

voices Lisa showed signs of paranoid and

delusional thinking she is acting on

these delusions by trying to protect

herself with a knife and by sleeping

alone in the garden

shed so tell me a little bit about the

voices they're horrible they sound

really horrible things to me yeah they

say that I'm I'm not I'm not any good

and that I'm

ugly and say that I've got to be careful

of jonno as well so what's that about do

you think they said that jonno is um

he's maybe trying

he's put a transmitter in my stomach and

I everyone knows what I'm thinking all

the time I've got to be careful i' I've

got to protect

myself you have to protect yourself from

somebody or is it from the camera yeah

from from inside and um I've got to

protect myself from uh

J I would have yeah be outside of the

house all the time so you've got to

protect yourself from jonno now okay so

are you scared that jono is going to

hurt you in some way oh I don't know

that's just what the voices are

saying

Lisa is hearing voices that are also

telling her she needs to protect herself

from jonno the counselor decides to

explore this issue further so she can

assess possible

risk I mean I was under the impression

that jonno had hadn't ever hurt you

prior has he ever hurt you no no he

hasn't hurt me he hasn't hurt me before

but I have to be careful of him because

the voice to say that he's going to hurt

me maybe has jonno ever hurt anybody

else no no no so it's the voices that

are telling you and they're also telling

you that you've got to be outside yeah

well I just go outside because I can't

trust being inside with the cameras and

I sleep in the garden shed because of it

so that must be pretty difficult too I

would

imagine and you're got to protect

yourself so so I guess sleeping in the

shed is one way of protecting

yourself are there any other ways that

you're protecting yourself yeah I I took

a knife so I've been sleeping with a

knife in the gun CH what would you do if

jonno came into the

shed I would have

to sorry what did you say I just said

what would you do if Jon o came into the

shed I have to protect myself are you

are you scared that you might hurt him

yes okay

okay laser is sleeping with a knife and

feels she needs to protect herself from

jonno a full risk assessment needs to be

conducted with

Lisa I guess at this point it's just

asking you a little bit about you know

how your drug use has been things going

with all of

that yeah I'm I'm still smoking bit of

pot any other

drugs yep some speed okay so the speed

cuz the last time that you were in you

hadn't been using speed for a while so

has it increased a little bit do you

think yeah I've been doing it a bit your

medication I'm mindful that you've been

on that for quite a while now how's that

going uh I don't know where my

medication is oh okay so could it be

with mom do you think or I might be I

haven't been able to find it so have you

been concerned that you haven't been

taking it a little bit I don't know cuz

I can't I've been looking for it and I

can't find it so is it a while that you

haven't taken any

medication yeah it's I can't remember

the last time you've been in the new

house a couple of weeks so do you think

it's possible been perhaps a couple of

weeks since you haven't had Med your

medication cuz Mom used to always give

it to you didn't she yeah yeah I haven't

seen it since I moved what's happening

with Mom and Dad they don't want me to

move out so um they got really angry at

me and I'm not really talking to them at

the

moment okay so were they worried about

you and Jonah moving in or what was

wrong don't they didn't want me to move

in with J oh

okay Lisa I'm feeling a little bit

concerned that you might be getting

unwell again and that might be what's

making you feel rather worried and

scared at this

point could be I don't know

maybe it maybe it is I'm just wondering

how you would feel if we connected with

your mental health

worker how do you think that would be

for you to see her yeah just so that she

can get an understanding of what's been

happening again with the voices

yeah

okay working in

Partnership Jenny checks her

understanding with Lisa by summarizing

and then works cooperatively with Lisa

in in the referral

process okay so shall I go ahead and

phone would you like me to do that now

well I could do it now if you'd like me

to yeah you can do it there okay we set

up an assessment and and see how things

are for you

then oh good afternoon can I speak to

the duty officer

please

oh good afternoon it's Jenny Robinson

here I'm a counselor with the local

community drugs service I have a client

with me at the moment Lisa day Lisa is

hearing voices and she's feeling quite

afraid and she thinks that she is being

spied upon and that her boyfriend may

have inserted a transmitter into her

stomach I'm a little bit concerned about

Lisa's boyfriend because the voices are

actually telling Lisa that she needs to

protect herself from him Lisa is

sleeping in the shed with knife under

her pillow um Lisa has relapsed from

speed use previously and she is has

commenced using speed again possibly

about twice a week over the last two

weeks and she hasn't been taking her

medication could we set up an

appointment

please Lisa would 2:00 this afternoon

suit you and would you be able to get up

there okay um 2:00 would be wonderful

thank

you

to complete the msse assessment the

following was

observed Lisa's speech and language was

normal and she did not appear to be

depressed however she was quite anxious

and

agitated Lisa was not able to remember

her new address and had misplaced her

medications she also found it difficult

to concentrate during the appointment

otherwise she was alert and orientated

to time and

place Lisa showed insight and judgment

she was willing to consider that the

experiences she was having could be due

to a reoccurrence of her mental illness

and she was agreeable to the Mental

Health Service being contacted for

further

assessment