NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] https://www.youtube.com/watch?v=Ga3OsA4uwa4 Speaker 1: We’ve had a call this morning from Central Surgery Practice regarding a request for an urgent assessment. I’ve got the referral here from the GP. It’s regarding Steven Jackson. “I’d be grateful if you could see this man urgently. Today his mother called me by phone to say she’s worried. He has a history of schizophrenia and aggression, and recently stabbed his father. He’s recently left a hostel to return to live with his mother. I feel the mother is scared of him. I believe his niece also visits, but mum says there are no risks to her. He hasn’t picked up any meds in months from us.” So that’s the referral. I’ve got the rest of his notes here. He’s a 30-year-old white man diagnosed with paranoid schizophrenia some four years ago. Dr. Sam Metta: Does it say what the relapse signs are? Speaker 1: Part of his delusions were to do with this family. He frequently believed he was being tortured or followed by the mafia, and he believes his father was involved with the secret police. He’s been in treatment with us since then, although we lost touch with them for a while when he went to Spain to visit his dad who was working there. Whilst there, he stabbed his dad with a penknife, who then had to be admitted to hospital. Steven was deported back here, and referred to forensics, who took over his care for about a year or so. They viewed him as a potential risk to his family. There’s a complex relationship with his mum. He’s got a younger sister who’s got a daughter who will be about three now. The daughter and the sister both live with the mum. Speaker 1: What else have we got? There’s a history of cannabis use and this has been said to exacerbate his mental health problems. In fact, last year there were a couple of episodes of serious violence. Dr. Sam Metta: What about alcohol? Speaker 1: Uh, don’t know. Dr. Sam Metta: And medication? Speaker 1: He’s on olanzapine, 20 milligrams, but he’s got a history of noncompliance. We mentioned the cannabis, haven’t we? There’s no history of self-harm or suicide, though. His father died last year and subsequently there have been tensions with the mother. She’s very supportive and so she’s never felt under direct threat from her son, but has from time to time had to take action. For instance, she once hid all the knives in the house, which brings us to the point really. The mother rang the GP this morning. She seemed quite anxious, as NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] we’ve heard from the referral. She’s doubting that he’s taking his medication and his behavior has been quite erratic. So, we need to work out how we’re going to tackle this don’t we? Philippa Dawson: Yeah, absolutely beautiful. Dr. Sam Metta: I have heard. Philippa Dawson: Yes, beautiful weather, and always a little bit of a breeze you know, so you never get too [crosstalk 00:02:52]. NURS 5274 University of Texas at Arlington Schizophrenia Patient Education Questions

Dr. Sam Metta: Really? I’m long overdue a holiday. I was actually thinking about going there next year. Philippa Dawson: Oh, you should. It’d be a nice place to go- Dr. Sam Metta: I think we might actually be here. It is number nine, isn’t it? Yes. [inaudible 00:03:04] Sorry, what’s his name? Philippa Dawson: Oh, Steven Jackson. Dr. Sam Metta: Steven … okay. Brace yourself. Steven Jackson? Steven Jackson: Yeah? Dr. Sam Metta: Hello there. We’re from the community mental health team and we were wondering if we can have a chat with you? Steven Jackson: What about? Dr. Sam Metta: Well, why don’t we come in and we can tell you all about it. Philippa Dawson: Thank you, Steven. Steven Jackson: Through there. Go and take a seat over there. Philippa Dawson: Sure. Steven Jackson: Want a cup of tea [inaudible 00:03:54]? Philippa Dawson: No thank you. Dr. Sam Metta: No, I’m fine. Thank you. NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] Steven Jackson: Sure. Fine. Steven Jackson: Fuck’s going on? Speaker 5: What do you mean? Steven Jackson: You’ve been aggressing up or something? Speaker 5: I don’t know what you’re talking about Steven. Steven Jackson: I’ve got the fucking mental health here. You better not be behind this. Steven Jackson: The kettle’s on. So what’s all this about? Dr. Sam Metta: Well, first of all, thanks for seeing us today Steven. I’m Dr. Metta. We’ve not met before, have we? I’m a psychiatrist, and I’m part of the team that’s looked after you in the past. The reason we’re here today is because your mum rang the GP and she was just a little concerned about you, Steven. Steven Jackson: What do you mean? Dr. Sam Metta: Well, she rang and spoke to the GP because she was just a bit worried, so we thought we’d come and see how you are. Steven Jackson: What do you mean my mom’s been ringing you? What she been saying? Dr. Sam Metta: Well before we get into that, it’ll be really useful to hear from you how you’ve been feeling recently. Steven Jackson: I want to know why my mum has been ringing you up. Dr. Sam Metta: Okay. Yeah. It’s nothing to worry about. Schizophrenia Patient Education Questions. It’s just that your mum was worried that you might have been avoiding taking your medication recently, that’s all. How have you been getting on with the medication? Philippa Dawson: We just want to make sure you’re okay, Steven. Was that your mum in the kitchen, just now? Steven Jackson: What’s she been saying about me? Dr. Sam Metta: We don’t want to upset you. Your mom’s not been saying anything about you. She’s just a little concerned. So we’ve come to check that everything’s okay with you, that you’re not in any trouble. We’re just here to see how you are. Are you okay with that? NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] Steven Jackson: She made me mow the fucking grass when it was wet. What she trying to do? Kill me or something? Stupid bitch. That’s why she’s shut in there. She tries that one again, she’s had it. Dr. Sam Metta: How long has it been since you’ve been back at your mom’s? Steven Jackson: Not long, a week. Dr. Sam Metta: Does it feel a bit weird? Steven Jackson: What? Dr. Sam Metta: Being back here after all that time. Steven Jackson: No. Dr. Sam Metta: I wonder how that tea’s getting on. Dr. Sam Metta: All right, so, he’s been back for about a week. Philippa Dawson: Yeah. Dr. Sam Metta: Steven Johnson is his— Philippa Dawson: That’s right, yeah. Dr. Sam Metta: He’s number nine. I think the next one is number nine. Yes. Here we are. Okay. Dr. Sam Metta: Hello, there. We’re looking for Steven Jackson.NURS 5274 University of Texas at Arlington Schizophrenia Patient Education Questions

Oh, hello there. My name is Dr. Sam Metta and this is Philippa Dawson. She’s a social worker. Philippa Dawson: Hello. Dr. Sam Metta: We’re from the Community Mental Health team and we were wondering if we could have a chat with you. Steven Jackson: What about? Dr. Sam Metta: Well, your GP asked us to come around and see you. So we’re here to make sure that you’re okay and everyone in the house is okay. Steven Jackson: We’re fine. NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] Dr. Sam Metta: Would you mind if we came in to talk to you, Steven? It’ll be really good to catch up with how things had been going for you lately. Dr. Sam Metta: Do you want to lead the way? Steven Jackson: Come on, then. Close the door. Dr. Sam Metta: Thanks very much. Philippa Dawson: Thank you, Steven. Steven Jackson: She won’t sit there. Dr. Sam Metta: Do you mind if I sit here, Steven, would that be all right? Steven Jackson: All right. Dr. Sam Metta: Philippa, do you want to— Philippa Dawson: Sure. Dr. Sam Metta: Thank you. Philippa Dawson: Thanks. Dr. Sam Metta: Sorry, Steven, would you mind very much if we were to put our stuff on the table? Steven Jackson: No, go on then. Dr. Sam Metta: Would that All right, yeah. And I’m just going to move this down over here if that’s okay. Steven Jackson: All right. I’m just going to make a cup of tea, do you want one? Philippa Dawson: Not for me, thank you, Steven. Dr. Sam Metta: Oh, I’m fine, thanks as well. Steven Jackson: Fuck’s going on? Speaker 5: What do you mean? Steven Jackson: You’ve been aggressing me up or something. NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] Speaker 5: I don’t know what you’re talking about, Steven. Dr. Sam Metta: What time did you say you’d call the team to let them know we’d be back? Philippa Dawson: 12 o’clock. Dr. Sam Metta: Okay. Steven Jackson: Kettle’s on. Dr. Sam Metta: We didn’t realize someone else was in. Steven Jackson: Yeah, my mom. It’s her house, isn’t it? Philippa DawsonSchizophrenia Patient Education Questions. : Would you mind if we had a quick word with your mum? Steven Jackson: Yes, I would mind. Anyway, she’s busy. Dr. Sam Metta: What’s she doing? Steven Jackson: Cooking. So what’s all this about anyway? Dr. Sam Metta: Well, first of all, thanks for seeing us today. Perhaps we should introduce ourselves properly. I’m Sam Metta, and I’m a psychiatry doctor. And this is my colleague. Philippa Dawson: Hello, Steven. I’m Philippa Dawson and I’m a social worker. Dr. Sam Metta: We understand you’ve just recently come back to live with your mum. Is that right? Steven Jackson: Since last week. Dr. Sam Metta: Did you tell your mum just now who we were? Steven Jackson: No. Philippa Dawson: Will she got a bit of a shock if she comes out of the kitchen and sees two strangers in the house? Steven Jackson: She won’t come out. Dr. Sam Metta: Why is that? NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] Steven Jackson: She just won’t. Dr. Sam Metta: Okay. So tell us who else lives here. Steven Jackson: Just me and my mom. Dr. Sam Metta: But I noticed there are a few toys around. Steven Jackson: That’s my sister’s little girl. She’s around some times. Philippa Dawson: Awe, what’s her name? Steven Jackson: [Ashlynn 00:09:32]. Philippa Dawson: That’s a lovely name. How often does she visit? Steven Jackson: Oh, most days after nursery. Her mum works. Philippa Dawson: And does Ashlynn stay the night? Steven Jackson: No, she goes home for dinner. Philippa Dawson: Okay. Steven, would you mind if just for our records, if I took a few details about Ashlynn? Steven Jackson: If you must. Philippa Dawson: Okay, thank you. It’s just to keep everything up to date on our files. What’s her full name? Steven Jackson: Ashlynn Kingston. Philippa Dawson: And date of birth? Steven Jackson: She’s 3. Her birthday’s March 10th. Philippa Dawson: Okay. And what’s her address? Steven Jackson: 14 Queen Street. NURS 5274 University of Texas at Arlington Schizophrenia Patient Education Questions

It’s around the corner. Philippa Dawson: And what nursery does she go to? Steven Jackson: I don’t know. It’s on Queen Street. NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] Philippa Dawson: Okay. Okay. Thank you very much. I bet she’s a bit of a handful. Steven Jackson: [inaudible 00:10:28] tits. Sometimes she’s all right. Sometimes she just moans. Dr. Sam Metta: And how does that make you feel? Steven Jackson: Pissed off. Dr. Sam Metta: And what happens when you get pissed off? Steven Jackson: I end up shouting at her or go out. Dr. Sam Metta: Oh, where’d you go? Steven Jackson: Around my mates’, just to get away from the noise. Dr. Sam Metta: So you were in the Kingsway hostel up until last week. And how was that? Steven Jackson: I hated it. It was fallen [inaudible] I’ll just hate feeling trapped like that. So it’s a shithole. Dr. Sam Metta: So what’s it like being back here? Steven Jackson: It would be all right if my mum didn’t keep winding me up. She made me mow the fucking grass when it was wet. What’s she trying to do, kill me or something. Stupid bitch. That’s why she’s in there. She tries that again, she’s had it. Dr. Sam Metta: Steven, would you mind if we spoke to you and your mum together? Steven Jackson: Leave her out of it. Dr. Sam Metta: I understand you were on medication recently. How was that? Steven Jackson: I’ve stopped it. It’s not working. Dr. Sam Metta: Well, in what way? I mean what would you have liked the medication to do? Steven Jackson: Just chill me out, help me sleep. Instead it made me fat, and I couldn’t get it up. NURS 5274 “Assessing Someone Who Is Potentially Psychotic and Dangerous in the Community” [00:14:36] Dr. Sam Metta: That doesn’t sound very pleasant. Some drugs can have that effect, I’m afraid. We can try you on another one that suits you better and will help you rest. What goes through your mind when you’re lying awake? Dr. Sam Metta: Do you hear voices? Steven Jackson: They tell me to do things. Dr. Sam Metta: What sorts of things? Do they ask you to do things you don’t want to do? Dr. Sam Metta: Are you hearing them now? Is it mainly at nighttime you hear them? What did they tell you to do? Steven Jackson: Private stuff. Family things. Dr. Sam Metta: To do with your mum? To do with Ashlynn? Anyone else? Do the voices tell you to harm your mum? Dr. Sam Metta: Steven, does any of this worry you? Now, I know you don’t want us to talk to your mum, but she may want to talk with us. What do you think about that? Steven Jackson: Okay. …Schizophrenia Patient Education Questions.