Primary Care of the Psychiatric Mental Health Client II

Crisis Management Case Study Video Transcript

Juanita is a 23-year-old single female of Guatemalan descent who is residing in an apartment with her five-month-old infant son. Juanita is currently unemployed and receiving disability benefits and food stamps and is on Medicaid. Paternity of the child has not been determined, and the father is not involved. Juanita's parents were divorced when she was five years old, and she has one older sister and one younger brother still in high school. Her mother remarried and has two young children at home. Her father moved out of state and has maintained only minimal contact with her. Due to her disruptive behaviors as a teenager, Juanita's relationship with her mother is strained.

Juanita has been receiving mental health related services since she was age 13, including services through her school district. She struggled in school, and obtained her GED when she was 20. She has a history of self-injurious behavior (cutting and burning thighs, arms, and abdomen) and had two suicide attempts three years ago when she was hospitalized at the state hospital for two months.

Juanita has been receiving treatment with the local assertive community treatment (ACT) team and, until her pregnancy, was doing well. She experienced several medication changes when she got pregnant, and after the birth of her son, Juanita’s mental health started to decompensate. At the time of the regular scheduled visit with the ACT team nurse practitioner (NP), Juanita was found to be in considerable distress. She had multiple minor cuts on her arms, legs, and stomach, and she reported she had not slept for two nights because her son had been crying.

Juanita admitted to not showering or changing her clothes for several days. The baby appeared to be physically OK, but was dirty and needing to be changed. The baby was hungry and crying. Juanita expressed having thoughts of suicide and hinted that she had a plan in mind, but she would not elaborate on the plan. She stated she “would rather be dead than be hospitalized and have her son taken away by social services.” The ACT team NP did not feel it was a safe situation to leave Juanita in the apartment with her son.