Ronnie is a young male who has a variety of needs as he struggles with day-to-day activities. He has experienced a deprived life from a young age and lost both his parents very young. Whilst living with his grandparents when he was younger, his behaviour began to worsen until he entered the residential care system. It was around this time his substance misuse began and he assumed this behaviour to be normal. At the age of 22 he lost his house and he had entered the prison system multiple times when an intravenous drug use became apparent. Ronnie became homeless and had developed a DVT and required heparin therapy in hospital. His intravenous drug use has put Ronnie at serious risk of blood-borne infections and dependence.
Ronnie’s Needs
Ronnie has developed post-thrombotic syndrome and swelling issues from his DVT which has led to increased pain and reduced mobility. To fully meet Ronnie’s physical needs, it would be required that he undergoes an intensive treatment plan of physiotherapy twice weekly to improve his mobility. He would need the application of a pressure stocking as he is a severe risk of further DVTs developing. For his physical needs to be completely met, he would not be a candidate for treatment at home as the risks of falls due to mobility issues remains high, as well as requiring hospital based heparin therapy, it would be impractical and unfair to expect Ronnie to travel with his mobility issues into a hospital by public transport to receive this treatment.
Ronnie has very complex emotional needs which he requires care and assistance with. Due to his traumatic childhood and upbringing, Ronnie has developed severe trust issues with violent outbursts of aggression and hostility. He should be referred to the psychiatric team at his local mental health unit for one-to-one meeting with psychiatrists and mental health nurses to talk through the underlying issues using cognitive behavioural therapy and try to develop a coping strategy to prevent further outbursts. Ronnie is at risk to himself through suicidal ideation and others through his violent outbursts. To prevent risk to Ronnie and the public from assault, it would be preferable for Ronnie to be treated in an inpatient unit with specialist staff he can work with and learn to trust, so they can adapt some of his behaviours using antipsychotic and antidepressant medication under supervision and therapy sessions to identify causes and triggers. It would not be safe for Ronnie to be treated at home currently due to these risks.
Ronnie’s social needs are a driving factor in his recovery. He has a very limited social circle with few friends and support networks, increasing the risk of relapse on both the use of intravenous drugs as well as a deterioration in mental health. Initially it would be beneficial for Ronnie’s social worker to place him in a voluntary work setting, in which he could meet other likeminded people to improve his social skills and bonds whilst potentially studying for job related qualifications to increase employability. By placing him into this setting, it allows him to build safer, functioning social bonds with a mixture of different people, allowing him to set up his own support network. It would be extremely beneficial for Ronnie to be cared for at home or in a community setting in this instance as the same level of involvement in his permanent local community could not be achieved in a hospital setting.
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Human Development and the Effect on Ronnie
Studying of human development involves looking at how people change and develop throughout their lives from conception, through childhood and into adulthood and ultimately death. There are different strands of developmental areas which occur at distinct stages of an individual’s life: Social, Physical, Emotional, Cognitive and Cultural. The stages of one’s lifespan can be considered to be: Infancy, Childhood, Adolescence, Adulthood and Elderly.
In terms of emotional development, Ronnie’s father left home and his mother died of a heroin overdose when he was in his childhood stage. Emotional development at this stage is usually associated and facilitated by cognitive development. The lack of parents for Ronnie at this vital stage in life prevented him from learning the vital communication skills necessary for the ability to become a functioning member of society. With the lack of communication skill building at this life stage, it has caused Ronnie to become unable to build functioning relationships later in life, causing isolation and loneliness. Parents play a vital role at this stage, by providing love and reassurance to the child to aid confidence building, something which Ronnie lacked.
Ronnie’s social development at the adult stage is heavily influenced by all other aspects of development, however it has an effect on Ronnie later in life in its own right. Socialisation is the process of how one develops social bonding with other people, with the goal of achieving a functioning social role in their society, by understanding its norms and values. At his adult stage, Ronnie has little to no social improvement from his adolescent stage. For example, Ronnie is not in employment and never has been. The lack of employment fails to provide Ronnie with a sense of his role in the world, as well as a lack of purpose and worth. By failing to undertake employment, Ronnie has not developed necessary social skills to become successful, or the skills necessary to convey and form his own thoughts and opinions about his addictions, disabilities or treatments and therefore hindering a successful recovery.
The correlation between these two developmental strands is that they are both hindering Ronnie’s recovery in the present through a variety of factors. Development through his childhood into his adulthood has prevented his communication skills from developing to a standard in which he is able to effectively communicate how he is feeling regarding addiction, substance misuse and the relevant treatment for his associated health conditions. Due to the absence of his parents, Ronnie has developed severe trust issues which puts in him a difficult situation in terms of trusting practitioners involved in his treatment, slowing down his overall recovery time.
In terms of Ronnie’s psychological development affecting his care, it would be beneficial for his care to provided at home in a community setting. This would aid his emotional development by allowing confidence building in a setting that is comfortable for him. By a care worker treating Ronnie in his own home, it prevents unnecessary anxiety and stress from being in a hospital setting. Care at home would benefit his social development in that it would allow him to be cared for in his local community. His care worker could place him into a voluntary work setting to allow him to gain work related skills and qualifications, and also allows him to meet like-minded people, therefore developing safer, functioning social bonds which will aid his recovery and lessen the chances of relapse.
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Psychological Theories Applied to Ronnie’s Care
Erik Erikson’s (1902-1994) Lifespan Theory takes a psychodynamic approach. Erikson’s eight stages of development theory teaches that a person is faced with a crisis at eight distinct points in their life – at infancy, toddlerhood, pre-school, school age, adolescence, young adulthood, adulthood and maturity. Erikson teaches that human development is determined by past experiences, and that each person much solve their crisis to progress to the next stage of life, with each stage having a positive and negative outcome. Failure to solve these crises can have damaging psychological effects as it causes the person to become stuck at that stage until they can develop a plan to move forward, which is often extremely difficult. In application to Ronnie, it would appear that he is trapped in the adolescent stage, with his crisis being “Identity versus Role Confusion”. Ronnie fits well into this category as it is the stage that is between childhood and adulthood. The theory teaches that as a child, Ronnie should have been undertaking the process of learning his society and identifying himself and his purpose in life, however due to him moving homes frequently, being in the care system and losing his parents very young, he was never taught the societal norms and values which would have allowed him to develop successfully past the adolescent stage. His lack of identity is likely to be causing a role confusion, causing him to make commitments such as misusing drugs and participating in crime and therefore he has become stuck in a vicious psychological cycle. This cycle is damaging to Ronnie as although he has physically moved past this stage, he still carries the weight of the unsolved crisis with him and it is preventing him from progressing into the young adulthood stage of “Intimacy versus Isolation”. This stage becomes apparent in the sense that Ronnie cannot progress past it as he has not cleared the previous stage, therefore he has not developed a capacity for intimacy or work and he is becoming isolated and withdrawn because of this. This theory has strengths in that it is better for Ronnie to be cared for at home, as a care worker could use a combination of therapy and community placement opportunities to come up with an action plan for him to address the issues of him not understanding societal norms and work with him to develop the necessary skills needed for him to find his identity and an ambition for work and intimacy, therefore pulling him out of his isolation and substance misuse.
Albert Ellis’ (1913-2007) Rational Emotive Behaviour Theory teaches that happiness influenced by positive thinking and that early conditioning has a major role in our thinking processes. Ellis believed that people playing over bad experiences results in a complex of negative reinforcement and that in turn affects people’s mood and thinking in the present day. Ellis believed humans had shared goals of staying alive, being happy, productive and the ability to form functioning relationships, amongst others. He believed that if a thought was rational, it helped us to achieve these goals, however humans also have irrational beliefs which we are unlikely to help us achieve the main goals we have. These behaviours lead to laziness and procrastination in terms of achievement of these goals and therefore promote negative thinking and psychological problems when the goals are not achieved. In application to Ronnie, he has a plethora of negative thinking in regard to his relationships, both romantic and social, and also to his general happiness. His relationships are generally damaging, in that he has spent a significant amount of time in prison and socialising with harmful people, engaging in short-term happiness activities such as using alcohol and drugs. He has adopted a lack of trust in his familial relationships due to the abandonment by his grandparents and as a result he has adopted irrational thinking towards relationships with
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family and his general happiness, which fits well with one of Ellis’ three basic irrational beliefs “You must act kindly and considerately and justly towards me or else you amount to a louse”. Ellis describes here how Ronnie is contributing to his psychological problems by thinking that his family have not treated him kindly and considerately and therefore he will cease to have any functioning relationship with his family to prevent reoccurrence of a past hurt. He is clinging on to negative feelings and the negative connotations his family bring to him. He is applying blame to them and is damaging the potential he has to achieve his main goal of a functioning relationship with them. This theory would best be applied if Ronnie were to be cared for at home and visits someone such as a counsellor or a community psychiatric nurse in an interdisciplinary team with the inclusion of a psychologist, who together could work through Ellis’ ABCDE model. Together, they could work with Ronnie by replacing the irrational beliefs he has developed by first identifying; the (A)ctivating event which caused the irrational belief in the first place, identify his (B)elief, which is the thoughts that he has about the event that occurred, the (C)onsequence of the event that happened, this stage helps the practitioner and Ronnie identify how he is feeling. The (D)isuputing part of the process is helping Ronnie to identify his rational thoughts against his irrational thoughts. Finally the (E)ffect, helping Ronnie realise his new and rational thinking process and how he can apply this to his life. This theory has strengths in that it allows for Ronnie to be care for at home effectively as at each stage, the practitioner treating Ronnie could ask him to do things in the community which back up what they discussing in their meetings. It would work in a positive way for Ronnie because by showing him how his negative thinking process is working and giving him practical activities to back this up rather than just telling him he isn’t thinking positively enough, it greatly increases his chances of recovery.
Carl Rodger’s (1902-1987) Person Centred Theory is a humanistic approach and focuses on the individual and their beliefs on self-opinion and worth. The theory teaches that people can lose their individual beliefs and feelings due to the pressure of socialisation, especially when they are young. It describes a condition of worth from peers in that you are accepted by them if you confine into the expectation they have of you, even if that expectation is drastically different from who you are as a person. This is applied especially well in adolescents who are experiencing the social challenges of high school and trying to find their identity, where conditions of worth may alter one’s personality. This can cause a person to develop what Rodger’s calls an external locus of evaluation in that people become too influenced by their peer’s opinion about them. When considering Ronnie, it is important to recognise that during his adolescent and young adulthood stage is when the majority of his problems began. Other children at school all had loving families and Ronnie has previously stated this made him very angry, likely due to the condition of worth the children placed on him that he came from a normal family background like they did and treated him negatively and didn’t accept him socially because he didn’t. This theory also comes into practice in that his newly found early adulthood friends were all involved in intravenous drug abuse. The condition of worth placed on Ronnie by these friends for him to be socially accepted by them, is that he began the use of these drugs, which started his addiction. It would be extremely beneficial for Ronnie to be treated at home with this theory because a specialist drug misuse worker could use this theory to identify how Ronnie’s drug misuse began and guide him into functioning social relationships. For example, if Ronnie was to be treated in an inpatient unit for drug misuse, he would be socialising with other addicts. Although this can be beneficial for the development of some of the psychological coping
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methods associated with addiction, if these friendships continued outside of the hospital setting and one friend suffered a relapse, as Ronnie has a very limited social circle and already proven on numerous occasions he is extremely susceptible to conditions of worth being place upon him, it could increase his risk of relapse. However, if provided treatment at home in a community setting, it would allow him to realise his potential by discrediting previous conditions of worth initially by working with a practitioner who could then encourage him into an employment setting, before then developing relationships with others who are not necessarily in the same situation as him. It is beneficial for Ronnie to be cared for at home using the Person Centred Theory in that it dramatically decreases his risk of relapse.
Impact of Social Influences on Ronnie
One important social influence on Ronnie is his peers. During Ronnie’s childhood and adolescence, he developed relationships with people who were very damaging individuals. These people encouraged Ronnie to participate in crime and violence in order to fund the opiate addiction they introduced him to. This had a significant effect on Ronnie’s life chances by hindering his chances at a successful education and employment opportunities. Ronnie, due to this addiction became homeless and is suffering from a variety of health problems.
Another social influence on Ronnie is the government. The government pass many laws related to drug abuse which criminalise addicts instead of treating it as a health issue and through the Misuse of Drugs Act of 1971, Ronnie is risking heavy prison sentences and fines if he is caught in possession of controlled substances. This pushes Ronnie into isolating or potentially dangerous situations with harmful groups of people in order to protect the continuation of his addiction, only adding to his problems. This risk of being caught increases Ronnie’s anxiety from his underlying mental health condition which decreases his likelihood of seeking help.
Society has a negative influence on Ronnie, which is partly facilitated by the government’s actions. Society are taught so heavily from a young age that drug use is bad and they should not engage with people who are misusing drugs. This demoralising attitude towards addicts causes people to subconsciously look over an individual who seriously needs help and therefore Ronnie failed to get the intervention that so many addicts require.
The correlation between these social influences is that they prevent Ronnie from recovering and redeveloping safe relationships. This pushes Ronnie into increasingly difficult situations and leaves him with nowhere to turn and no one to ask for help in terms of his addiction. He cannot ask his peers for help as they are also abusing drugs and he fears asking any other societal member due to fear of prosecution or mistreatment by them.
Taking social influences into account, it would not be beneficial for Ronnie to be treated in a home setting. These influences cause mounting pressure for Ronnie by not knowing who to turn to or how to achieve successful cessation of drugs. By treating him at home, it provides a real risk of non-compliance with treatment as Ronnie will have a mistrust of whether to trust his carer or his peers on what the right thing to do is. By treating Ronnie in an in-
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patient unit, these risks are reduced to zero and a guarantee can be made that Ronnie will be successfully enrolled into a substance abuse programme. Treating Ronnie as an inpatient also allows monitoring when it comes to a withdrawal. It is much safer for him to undergo a withdrawal under medical supervision than to risk psychotic episodes, relapse or death if he was dealing with it with limited supervision at home. Caring in an inpatient unit also allows Ronnie’s psychological needs to be effectively addressed through medication intervention and more intensive counselling therapies.