CLINICAL INFORMATIONPart a). Comprehensive Mental Health Assessment Introduction:   Mark is a 35 yr old man partnered with his girlfriend Jude for 2 years. Both live together in a house they are renting in Mile End. Mark is employed full time as a tradesman carpenter. Jude is presently away interstate for work.  Situation: * Reason for Referral * Presenting Issue * Recent Significant Events or Stressors * Symptoms * Change in Frequency, Intensity, Duration of Symptoms * Collateral   Mark presented to the Emergency Department alone at approximately 10am, encouraged by his mother (Sue) who was concerned about his safety. At triage he described thoughts of suicide without a clear plan. He denies self-harm and denies overdose of medications.   Mark states he has a history of depression and anxiety which has worsened over the past 4 weeks. His symptoms are characterised by negative thinking with thoughts of suicide, poor sleep, anxiety with physical symptoms of psychomotor agitation, SOB, increased heart rate and thoughts of a fear of dying.   Marks mother Sue concurs that his symptoms have worsened over the past month as she has noticed his mood is low, he appears sad, tired and talks about wanting to quit his job which is unusual since he has moved to a job he has wanted to be in for the past year. Sue believes his mental state has been affected by news that his close friend Luke has been diagnosed with a medical condition, possibly leukemia. She has known Mark to be suicidal in the past (approx. 4 years ago) but that since engaging with a psychologist, his mental state has been much improved until recently.    Background: * Current Living Situation * Significant Relationships * Developmental History * Psychiatric History * Current Medication * Drug and Alcohol and Gambing History * Family History * Previous Treatment / Medication * Relevant Health / Medical Problems * Domestic Violence * Psychosocial * Allergies     Mark lives in secure rental accommodation in Mile End with supportive girlfriend Jude. They have been partnered for 2 years in a supportive relationship. Jude is currently away interstate on business and intends on returning home tomorrow. No dependants.   Supports: Jude partner of 2 years Mother Sue and Father David- very supportive and aware of Marks situation Psychologist Amber Davies GP Dr Raj   Developmental hx: Mark grew up in the family home with his mother Sue, his father David and younger brother Sam. Achieved expected developmental milestones. Described as a happy child with many friends at school. Enjoyed surfing and other outdoor activities such as playing soccer. During high school, a close friend of Marks struggled with mental health problems and their friendship impacted Marks mental state also. During this time, Mark began to struggle with his own anxiety which was supported with school counselling and GP. His self esteem was impacted negatively until adulthood.   Mark completed high school at the local public PS and high school, successfully completing year 12 and enrolling into a trade apprenticeship with a local carpentry company. Mark has worked hard with this team and was successfully promoted to new position in the past 2 weeks. Currently Mark feels he is not well enough to work in this promotional position and does not want to let his employer down given he is struggling and has difficulty focusing on learning the new role.   Psychiatric hx: History of depression and anxiety for the past 4 years managed in the community with supports including GP and psychologist. No hospital admissions for mental health. Suicidal ideation 4 years ago during an episode of depression. No self-harm or suicide attempt at this time.   Medication: Prescribed Escitalopram 10 mg daily. Adherent to treatment since being commenced by GP 6 months ago. No other medications prescribed.   Family psychiatric hx: David (Marks father) suffers from depression and his grandfather who is in a supported residential facility. No family history of suicide.   Drug and alcohol use: Alcohol use includes x2 standard drinks of beer after work each day. Recently increased to 6 beers per night in the past 4 weeks. Drug use includes THC each weekend approx. 2-3 joints across the weekend. Usually this is less regular. No gambling behaviours.   Medical history: No major health problems. Presents today with tachycardia which needs further investigation with regular observations, ECG and medical review. Back pain commenced 6 months ago and treated with physiotherapy and paracetamol. Back pain worsened in the past 2 weeks causing headaches and difficulty sleeping. Possible development of withdrawal symptoms (alcohol and THC) which need monitoring and treatment. No history of alcohol withdrawal seizures.   Denies allergies.  Mental State Examination:   * Appearance 35-year-old Caucasian male, casually dressed wearing clean clothing, blue tee shirt, jeans and casual lace up shoes. Within a healthy weight range. Short hair, blonde ends. Unshaven facial hair. Nose ring. Small tattoos on both hands. No visible scars.   * Behaviour Sitting in a chair. Cooperative with mental health review. Answering questions and engaging in conversation. No obvious psychomotor agitation or retardation. Very good eye contact. Gesturing appropriately with his hands. No self harm.   * Mood Describes mood as “really low at the moment”. Admits that he is feeling anxious and depressed.     * Speech Normal volume, rate and flow to conversation. Speech is clear and coherent. Australian accent.   * Affect   Affect is anxious and reactive and congruent to stated mood.   * Thought (form and content).   Normal thought form- nil formal thought disorder. Thoughts are clear. Thought content relates to negative thinking with guilt and thoughts of suicide without a clear plan, themes of feeling anxious with physical symptoms, and feeling supported by family and partner, wanting to access help for mental health.     * Perception   Nil perceptual abnormalities described or observed.   * Cognition function   Cognition is intact. Consumer is oriented to person, place and time. Memory is intact as consumer is able to recall recent events and historical events accurately. No cognitive deficits noted.   * Insight   Consumer presents with a good insight into his mental health as evidenced by his ability to identify unhelpful thinking patterns which are impacting his mood. He is able to recognise that his mental illness has relapsed and understands health promotion activities to support recovery.   * Judgement   Consumer demonstrates good judgement related to accessing health care and treatment for mental illness. Judgement related to suicidal thoughts remains intact as he does not wish to act on his thoughts and is following his Safety plan to ensure his own safety.   * Rapport   Rapport is established as consumer is trusting and engaging with health professionals in a collaborative manner and discussing the best treatment approach for his recovery.         “Strengths and skills” * Please identify the consumer’s strengths and coping skills when they are well. * Please include the perspective of the consumer’s family/carer.   Mark is a hard-working, successful carpenter recently promoted to a senior level position. He enjoys surfing and uses exercise as a coping mechanism along with psychological approaches such as ACT and mindfulness to manage his mental health and back pain.   Mark engages well with his supports and has good insight into his mental health and when he requires additional support. He is usually bright in his mood and has hope for the future but currently he is struggling with strong negative thoughts which impair his ability to rationalise.   Mark has a supportive network of family, friends, work colleagues and health professionals around him which he actively engages with when feeling unable to cope with symptoms of his mental illness.