There has been recent discussion about health reform and its potential impact in the community setting. With the implementation of a new or changed concept there comes a period of transition. Discussions that include exchanges of ideas to ease the transitional process may become very relevant if the outcome is projected as a positive one. The intent of this article is to foster an idea; promoting a new concept during this period of revision as it relates to the merging of two very important services. This includes services to the population affected by developmental disabilities and those that seek or require services in the mental health setting.
By profession I am a Registered Nurse. Although I am certified in psychiatric and mental health nursing and as a developmental disabilities nurse, nothing has prepared me more in the provision of services as being a parent to children affected by both. With that combined experience I found an enhanced ability to relate to others that are in fact impacted by similar challenges. The result is the engagement in functional solutions to help others reach their individual optimal potential in life.
Experience becomes our best teacher if we are aware of the presented opportunity. This submission will provide two real life situations that occurred in a mental health setting for the purpose of providing the education that captures the vision of the benefit that can be obtained by the creation of such a position. The details of these examples have been slightly modified for the purpose of confidentiality.
It’s a gloomy day. The rain is pounding on the roof top accompanied by loud cracks of thunder, bolts of lightning and inside lights flickering. Word has been received that an 18-year-old woman has found herself in a crisis situation with thoughts of taking her own life. Shortly she found herself in a mental health setting; very much confused with an overwhelming feeling of helplessness and hopelessness.
When I first set eyes on Mary, I did not encounter the stereotypical presentation one might expect from a depressed individual with suicidal ideation. I met a very well-groomed individual with sophisticated language enhanced with an air of such mannerism and politeness. We engage in conversation that revealed her life had turned so upside down that she could not “take” not knowing what was “wrong” with her any longer. She sought such relief because the tortured thoughts in her mind progressed to those focused of ending her life altogether. This was truly a tragic situation.
With the process of gathering information I was able to inquire and obtain information about Mary’s history that wasn’t listed on the standardized computer-generated questionnaire. My added experience in this particular specialty made this encounter a positive one. As we talked further and further, Mary felt the weight lift right off her shoulders. She felt like a changed woman simply from someone understanding what she was going through.
Conversation revealed she had many signs of Asperger’s Syndrome. She learned to read at a very young age and used sophisticated language. She did not “hang out” with people her own age and to this day described herself as having a social phobia. She always had focusing challenges but was always exceptionally bright in her area of interests. She possessed literal translation and felt it was difficult to maintain eye contact when conversing. She became confused about emotions especially when two different emotions co-existed. She laughed about her peculiar traits as it related to obsessions and compulsions. It was terrific to see this modification in her mood as we continued to talk.
I inquired if she ever heard of the term Asperger’s Syndrome. She became very excited and said yes. In fact an acquaintance several years ago; who actually had the syndrome, felt she too possessed similar characteristics. She said that her dad was actually going to look into this, but she has gone to Psychiatrists that have prescribed antipsychotic medications that were making her feel worse instead of better. She stated she was tired of all the medication changes. When asked if she ever was evaluated by a neurologist her response was “no.” As a child she was never examined by a developmental pediatrician.
We connected. It was very simple and uncomplicated. I reinforced that I was not a Physician and had no authority to diagnose but could provide information that she can discuss with the Psychiatrist about the consideration of such a diagnosis. We discussed reading materials, support groups and organizations should she be interested.
In that moment I watched a beautiful young lady exclaim excitedly her interest and reverse those feelings of helplessness and hopelessness as the weight lifted so effortlessly off her shoulders. We were both happy we met.
Then there was David. David was a teenager diagnosed with a developmental disability with a coexisting cognitive impairment who suffered with feelings of depression, triggered from the rejection of a desired first sexual relationship. He heard voices that reminded him of the event; replaying in his head over and over throughout the day. Those voices emerged into command hallucinations. As one can imagine, life became tortuous for David.
David’s mother was very supportive and quite educated about his disorder. Her love for her son was evident. She was quick to educate staff; covering feelings of her own helplessness. She came to us once before and was not pleased with the outcome, so she dreaded his return. She felt like there was no choice though, for her son’s life too, had spiraled out of control.
Staff complained of her overbearingness. Personally, I saw it quite differently. I saw a past part of me in her so relating came quite easily. I picked up the phone with a plan to anticipate her needs. Not only was she quite surprised, but her defensiveness became thin as the security rose in her voice. The conversion of helplessness and hopelessness to hopefulness came swiftly and naturally. The air seemed simply magical.
David was quite popular on the unit. His developmental challenges were evident in his looks and presentation. Although he had an auditory processing delay, he answered questions and expressed himself quite appropriately.
Quite often I find that individuals fall prey to IQ testing that was performed many years ago. Unfortunately results sometimes attach to them like metal does to a magnet. His expressions certainly did not match those IQ conclusions.
As in any mental health setting there are rules and regulations based on existing policies. However, modification within interpretation can be sometimes necessary to individualize effective plans of care. Being certified or educated with the specialty of working with the developmental disability population gave me the credentials needed for persuasion related to such modification.
Orders were received that allowed this gentleman to have his security bedding. It also allowed him to listen to his music in an isolative room under camera surveillance. To my surprise was the response; inflexibility of surrounding staff and support from all the patients that didn’t receive such privileges.
This was such a simple and reasonable accommodation for his disability, there were no explosive outbursts as disclosed in his history and he felt safe. With the mood stabilization, calm environment, and sense of security, therapeutic intervention soon followed.
A conference with both David and his mother became life altering. We discussed the use of classical music with headphones to manage the voices. We agreed that the lyrics in songs could trigger the reminder of the failed relationship. David was very excited. He shared that he really enjoyed classical music. We discussed referral to supported employment for David.
We discussed job coaching and opportunities for him to meet others in the community to aid in the development of healthy relationships and to help resolve the isolation, disturbing thoughts and depression that followed. We discussed IQ testing, cognitive behavioral therapy, self-talk and affirmations. David was equally excited and so was his mother. She could not believe the difference in her experience this time around. With permission, we all hugged.
David now had a sense of purpose and direction. If non-experienced nurses cross paths, I am confident such direction would not have been provided and the circle for this family would have continued. It is very important for professionals to listen and be alert to all presented disclosures that can provide the clues necessary to develop an effective plan of care.
Going through motions should not be in any repertoire when it comes to the preservation of life itself. Because of my experience and certification in developmental disabilities, the visit to our facility became life altering. I believe it is time for legislators and organizations to become more aware of the many specialized skills that Developmental Disability Nurses possess.
Yes, this is the time for health reform. Many people are now finding themselves with mental health challenges and many of those individuals have an existing developmental disability. The health management specialty of the Developmental Disability Nurse can help preserve life and should be viewed as a valuable asset to the healthcare system.
Joni Jones RNBC-CDDN, is a Registered Nurse, Board Certified in Psychiatric and Mental Health Nursing, is a Certified Developmental Disabilities Nurse, and is a member of the Developmental Disabilities Nurses Association (DDNA).