SWRK2002 – Assessment 1 Case Study

You are a social worker working in an inpatient mental health unit attached to a hospital in a large regional centre. You have been in this role for about six months, having previously worked in a similar position interstate. Your role involves working as part of an interdisciplinary team attached to the unit that also includes a doctor, psychiatrist, psychologist, occupational therapist and three mental health nurses. You also work closely with staff at the local community health service when planning the discharge and ongoing support of patients/clients.

For the past four weeks you have worked closely with one particular client, Cody, who is a 25 year- old transgender man (who’s pronouns are he/him). Cody was admitted to the unit as an involuntary patient following a psychotic episode and has previously been diagnosed with bipolar disorder. Through your time working with Cody, you have gained some insight into his life – which has been quite troubled. Cody was a ward of the state from the age of 13 and experienced multiple placements in out of home care and youth residential facilities. Since leaving care, Cody has experienced homelessness, transience and considerable instability in his life. These experiences have had a growing impact on his mental health, leading to two previous hospital admissions in other locations within the past eighteen months.

Following this most recent hospitalisation, Cody has begun a new medication and treatment regime and his health has started to stabilise. The team is now being asked to plan for Cody’s discharge and a meeting has been scheduled. You are aware from recent conversations that both the psychiatrist and treating Doctor are pushing for an immediate discharge as there is pressure to free up beds in the unit and both are of the opinion that Cody’s health has stabilised sufficiently for him to be discharged and for care to be handed over to the community mental health service.

From prior experiences you feel it is likely that others in the team, particularly the psychologist and mental health nurses, will go along with this decision because they are reluctant to question the judgement of the doctor and psychiatrist or to challenge the organisation’s practices when it comes to freeing up beds for new patients. Further to this, your experiences to date have been that although the team is supposed to function in an interdisciplinary way, in practice the higher-status members tend to dominate decision making. Compounding this issue, resource constraints have meant there is insufficient time allocated to team meetings and there has been no shared training since you commenced your role.

While you recognise the progress that Cody has made since being admitted, you do not think he is ready for discharge. You are particularly concerned that Cody’s only immediate housing option will be to return to the boarding house where he was staying prior to his hospitalisation. You know from your discussions with Cody that he felt very unsafe at the boarding house as nearly all of the residents are males and there is a lot of drug use and associated antisocial behaviours in the boarding house itself and the nearby area. While Cody says that he wants to leave, he has expressed concern that if he goes back to the boarding house he will soon end up back in hospital or worse. Furthermore, in the past couple of weeks you have been working with Cody’s allocated community mental health worker to source more appropriate accommodation. At a recent meeting, a worker at the local community housing provider indicated that a suitable transitional housing property could become available in about two weeks. In your view, it would be preferable for Cody to remain in the unit for a couple more weeks and then move into this property.

You now need to prepare for the discharge meeting knowing that your position will most likely conflict with those of the psychiatrist and doctor, and that other team members may be reluctant to support you if it means directly challenging the status quo within the team and the hospital more generally.