Chief Complaint: You All Are Morons, I Want To Go Home

Chief Complaintyou All Are All Morons I Want To Go Home Theres N

Chief Complaint: “You all are all morons! I want to go home. There’s nothing wrong with me and I shouldn’t be here. Do you see that there are alien doctors at the hospital, and they are helping to take over if we don’t do something to stop them?”

History of Present Illness: A 37-year-old woman brought into a psychiatric hospital by police after attacking an officer. She reports believing in an alien invasion, seeing aliens under the bridge where she lives, and asserting that alien doctors are taking over the hospital. She talks about poisoned water, alien rapists, and plans to stop the invasion. She denies being ill or needing treatment, indicating possible delusional thinking.

Past Medical History: Depression five years ago, treated briefly with antidepressants; lymphoma in remission; prior knee surgery complications; PPD for six years.

Family History: Mother with schizophrenia; maternal grandfather hospitalized for hysteria.

Social History: Homeless, disowned by family; has a daughter; previously employed as a nurse aide; no recent legal issues.

Review of Systems: Denies appetite changes or weight loss; reports headaches potentially related to past surgeries; focused on aliens, sleep interrupted by fears of invasion, no suicidal or homicidal thoughts.

Medications and Allergies: OTC ibuprofen; allergies to mycins causing stomach upset and Bactrim rash.

Physical Exam: Thin, disheveled Hispanic woman; vitals stable; no acute physical findings; neurologically lethargic but normal reflexes; no signs of acute distress.

Laboratory Results: Electrolytes normal; slightly elevated glucose; thyroid function normal; negative pregnancy and drug screens; urine specific gravity slightly concentrated.

Assessment: Not required for this assignment.

Plan: The focus is on identifying social determinants of health (SDH) affecting this patient and developing strategies to support her strengths and address challenges related to SDH.

Paper For Above instruction

The assessment of social determinants of health (SDH) is crucial for understanding and addressing the complex needs of vulnerable populations, such as homeless individuals with mental health issues. For this patient, three primary SDH have been identified: housing instability, social isolation, and access to healthcare. Developing a comprehensive plan to address these factors can significantly improve her mental health outcomes and overall well-being.

Housing Stability

Housing instability is a significant SDH impacting her mental health and safety. The patient’s homelessness under the bridge places her at risk for continued exposure to environmental hazards, violence, and difficulty accessing consistent healthcare services. To address this, collaboration with local housing agencies and the use of supportive housing programs can provide her with safe, stable accommodation, which is foundational for recovery and stability. Connecting her with programs such as permanent supportive housing or shelters that offer mental health support can promote stability and reduce hospital readmissions.

Furthermore, integrating case management services focusing on employment and social reintegration can improve her independence and reduce risk factors associated with homelessness. Ensuring she has access to social services, including housing vouchers and supportive housing programs, aligns with evidence suggesting that stable housing is linked to better mental health outcomes and reduces symptoms of psychiatric disorders (Kushel et al., 2003).

Social Support and Community Integration

Social isolation exacerbates her mental health condition, leading to delusional thinking and feelings of disconnection. Disowned by her family and living alone, she lacks a support system crucial for recovery. Interventions should include connecting her with community mental health services, peer support groups, and social workers trained in outreach to homeless populations. Building a supportive network can foster trust, improve treatment adherence, and reduce feelings of alienation.

Providing culturally sensitive and trauma-informed care is essential, as her history suggests past trauma and family disconnection. Community integration efforts, including participation in group activities and skill-building programs, can restore a sense of belonging and purpose. Research shows that social support correlates strongly with improved mental health and reduced symptoms in individuals with psychotic disorders (Pharoah et al., 2010).

Access to Healthcare and Continuity of Care

Limited access to healthcare services impedes her ability to manage her mental health effectively. Her homelessness and distrust in institutions are barriers to traditional clinic-based services. Mobile outreach programs and integrating mental health services into shelters or community centers can improve access. Providing low-barrier, culturally competent mental health care—such as case management, medication management, and psychotherapy—can stabilize her condition.

Establishing continuity of care through case managers and safeguarding follow-up appointments ensure ongoing treatment adherence. Incorporating telepsychiatry solutions might also facilitate consistent contact, especially given her transient lifestyle. Evidence supports that continuous, accessible mental health care reduces hospitalization rates and promotes recovery among homeless populations (Craig et al., 2017).

Conclusion

Addressing the social determinants of housing stability, social support, and healthcare access is vital for this patient's recovery journey. Multidisciplinary approaches involving social services, mental health providers, and community resources can mitigate the adverse effects of homelessness and social isolation. Ultimately, tailored interventions that recognize her unique needs and strengths will foster resilience and improve her social and mental health outcomes.

References

• Kushel, M. B., et al. (2003). Housing Instability and Food Insecurity as Barriers to Health Care Among Urban Homeless Adults. Journal of General Internal Medicine, 18(11), 1056-1060.
• Pharoah, F., et al. (2010). Family Intervention for schizophrenia. Cochrane Database of Systematic Reviews, (12), CD000088.
• Craig, T., et al. (2017). Mental health and homelessness: A review of research evidence. Australian & New Zealand Journal of Psychiatry, 51(11), 1029-1035.
• Kushel, M., et al. (2003). Housing instability and health: implications for health care reform. JAMA, 290(2), 196-203.
• Padgett, D., et al. (2016). Housing and Support for People with Serious Mental Illness. The Oxford Handbook of Social and Political Trust.
• Tsai, J., et al. (2013). Interventions to Improve Housing Stability for Homeless Persons with Serious Mental Illness: A Review of the Evidence. Psychiatric Services, 64(7), 677-683.
• Fitzpatrick, S., et al. (2013). The social exclusion of homeless people and its impact on health. Journal of Public Health, 35(3), 371-377.
• Sadowski, L. S., et al. (2014). Effect of Housing and Homelessness Prevention on Hospitalizations and Emergency Department Visits: A Systematic Review. Healthcare, 2(4), 360-374.
• Kidd, S. A., et al. (2014). Risk factors for homelessness among youth and young adults: A review. Journal of Adolescent Health, 56(1), 7-13.
• Brennan, C. M., et al. (2012). Social Connectedness and Community Engagement in People With Severe Mental Illness. Journal of Social Service Research, 38(3), 317-330.