Personal Responses to Psychiatric Strategies in Patient Assessment

            I remember in late last summer I had the opportunity to conduct a client intake interview on two homeless couples who looked well-dressed but wore faces that lacked emotion. After welcoming them to a sit, they took a little longer than I anticipated to sit or even answer back. In fact, the wife did not answer at all! They sat down and after a long stare and silent moment to which I had asked two questions and receiving no answer, the husband just simply jolted almost out of his chair and uttered the words, “ the shelter is killing madam, I need a job or at least a place to sleep, can you please help?” After calming him down, I simply asked him to just list all the problems he thinks he or they (as a couple) have that are currently causing them mental distress. He mentioned problems with lack of sleep because the shelters often harbored dangerous criminals, they had not eaten proper food for the past 2 day, and that her wife must receive sanitary towels by the end of the month but getting $20 was a problem. To put it verbatim, he mentioned that, “the last time she tried to sell, she was molested several times…” It was there that it then downed on me why his wife was very quiet and immobile from the beginning of the interview; she was a victim of rape. Any further questions I asked were only answered by the husband, which even complicated the matter further.

            Because at the very moment I heard the word “molested” I knew there was a bigger problem than just unemployment. I then took the next step, whereby, as a psychiatrist I prioritized their needs in a first A, B, C’s manner and then proceeded to the Maslow prioritization (Barker, 2004). Under this, I subjectively predicted that the silence and depression by the wife may have a huge part of it being caused by the husband. In order to draw attention away from the husband and reduce the risk of him realizing my conclusion, I proceeded to provide them with a 5 key Hamilton Rating Scale questionnaire and requested for their impartial answers (Barker, 2004). Three minutes later, they handed the questions to me, and to my surprise his wife, Susan, had suicidal thoughts which I could have easily confused with depression.

            Thereafter, I lied to the husband in order to get an opportunity to speak with Susan. The realization of suicidal thoughts on Susan made be intervene immediately and consider the well-being of Susan. This was because, even though his husband tried to hide his pain through endless chatter, a suicide by his wife will probably break him further and even worsen his current stabilizing mental condition.

Reference

Barker, P. (2004). Assessment in psychiatric and mental health nursing: in search of the whole person. Cheltenham, U.K: Nelson Thornes.

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