Comprehensive Assessment and Intervention Strategies for Destiny's Complex Mental Health Needs

1) Introduction: Destiny, a 17 years old identical twin is facing many physical and mental challenges in her complex family atmosphere. She lives in a public house with her twin sister Star, older half-brother Jamal, and their mother Janet. Her mother Janet also had a history of child abuse, family conflicts, multiple violent relations, substance abuse, and traumatic experiences with stroke. Even though Destiny has been diagnosed with anxiety, self-harming nature, and an eating issue, but still Destinys connection with Janet is not aligned. Her mother Janet frequently referred her to as the "bad twin." and her sister Star the good twin. Janet seeks help from Destinys school but due to her poor attendance and extreme self-harming activities couldnt help her. Destinys half-blood brother Jamal is unemployed and he has also been diagnosed with major depression issue. Destinys life has been very turbulent, marked by regularly admitting in the hospital sue to her severe eating disorders and self-harming nature. Janet has been very non-cooperative mother, as she refers Destiny's complications as a minor issue and even decline to take help with Child and Adolescent Mental Health agencies (CAMHS) (Guide to CAMHS | Mental Health Services, n.d.). Because of this, Destiny feels very isolated and refuse to attend the school, and shown signs of serious emotional suffering as well as physical illness. Her denial for her illness with her deceitful activities to keep destroy her health highlights the complexity of her mental health needs. Destinys desire to die and refusal to take sessions with psychologists clearly shows that how urgently she needs appropriate support and therapy.

2) Major life challenges: Destiny experience numerous major life challenges that significantly impact her life and overall well-being. Firstly, she has no one who loves her in her family which leads to severe mental health issues including eating disorders, depression, suicidal thoughts, anxiety, & determined self-harming behaviours. Destiny's adamant behaviour of refusing to take sessions with the mental health practitioners & denial of her illness exacerbate her vulnerability, posing a high risk of continuous self-harm and behaviours like self-poisoning. Poor family dynamics have worsened the Destinys difficulties. Destiny's connection with her mother Janet is characterized by miscommunication and a lack of attention to her mental needs. Janet's own background of trauma, substance abuse, and health problems, including a stroke, probably make it more difficult for her to interact with medical experts and offer sufficient assistance to her daughter. Additionally, Destinys twin sister Star is a good academic performer & she share a good bond with Janet which could further distance Destiny from family support. Jamal, having been diagnosed with depression & anxiety, he is jobless & socially isolated, making it difficult for him to provide support to Destiny. Even though having a family, Destiny does not receive the emotional support from her family. This kind of toxic and unsupportive family dynamics will risk the Destinys life as she deliberately wants to finish her life.

3) Comprehensive Assessment: A comprehensive assessment is crucial to better understand Destiny's mental issues and her family dynamics which is the core reason of affecting her wellbeing. Targeted therapies can be guided by this comprehensive awareness of her psychological and physical well-being, ability to socialize, and to make strong connections with her family. Considering Destiny's past of serious self-harming behaviours, eating disorders, & family trauma, a comprehensive evaluation including biopsychosocial, cultural and other relevant considerations in mind will be helpful in creating personalized treatment plan for Destiny and her family that will reduce the associated risks & encourage fast recovery of Destiny. Comprehensive strategies that include the challenges, key domains, methods and tools for assessment are described according to the needs of Destiny and her family.

The major challenges to engage Destiny and her key family members in the process of assessment and treatment are-

Refusal & Resistance: Destinys resistance and denying for taking sessions with medical health practitioner is a serious challenge to assess the severity of Destinys mental state and treating her. Neither Destiny nor Janet have accepted the seriousness of Destiny's mental health problems. Engaging the patient and her family is the first step to start the treatment. Studies suggests that due to many reasons, the patients refuse for the suggested psychotherapy assessment, deny for treatment, and stop taking their prescribed course of action (Knekt et al., 2021). These factors include external barriers, environmental factors, patients mental health severity etc. A number of demographic characteristics also leads to refusal for engaging in psychological sessions including male gender, adolescence age, low socio-economic status, unsupportive family, fear of being judged by the society, etc (Rubin et al., 2016). Destiny denial and resistance is due to her non-supportive family. Developing confidence through sympathetic conversation, psychological counselling about the circumstances, and gradually involvement in therapeutic procedures is necessary to overcome this barrier (Chakraborty & Bhide, 2020).

Family Dynamics: It is important to be consider the needs and viewpoints of each family member in order to resolve the tense connections among all. Trauma related to bad experiences carried out by one's own dysfunctional family, or unsupportive family makes a person underconfident, leads to suicide attempts, self-harming behaviours, & flashbacks (Ozturk & Erdogan, 2021). The unhealthy dynamics present in dysfunctional homes have a detrimental impact on children's developing personalities and foster a pessimistic outlook on life in general. They also cause suffering and irreversible emotional wounds (Mphaphuli, 2023). In case of Destiny, engagement of every family member is important to establish harmony between Destiny, Janet, Star, & Jamal. Due to Janets negligible nature & Jamals mental health issues, it is challenging to engage all of them for assessment and treatment. Engaging Destinys all family members can be possible by organizing the systematic family therapy sessions according to the family availability (Carr, 2020).

Social Interactions: Social interaction with the neighbours, friends, and community members is essential to be mentally fit and keep yourself familiarise with your near & dear ones. Due to the mental health issues and isolated behaviours of Destiny and her family members, it is challenging to evaluate Destinys mental health. Refusal to attend school is linked to multiple comorbidities like anxiety & depression affect half of the patients (Tobon et al., 2018). Poor academic performance (31%) effects on peer relationships (34%), family problems (43%), school abandonment (25%), hazardous habits, and attempts to commit suicide are short-term outcomes of school withdrawal (Tobon et al., 2018). School refusal is a serious problem in case of Destiny and its treatment is extremely important to treat Destiny. One potential treatment for encouraging Destiny to join school is Multifamily therapy (MFT) (Simic et al., 2021). MFT suggests that multiple families with a member afflicted with the same illness assist one another in forming a caring community (Rou et al., 2021). Participants can compare notes and gain knowledge from one other by exchanging thoughts and experiences with members of other families. When parents and kids engage in various activities in a group environment, interactions within and between families become more intense (Rou et al., 2021).

Key domains to be assessed in case of Destiny are-

• Physical or biological assessment: Evaluation of Destiny's present state of physical health, taking into account her eating disorder-related medical issues as well as her weight trends and nutritional condition is extremely important to take care her physical health (Berghfer et al., 2020).

• Psychological: Using standardized diagnostic tools and strategies, Destinys mental health symptoms, including suicidal thoughts, self-harming activities, depression level, and anxiety can be evaluated (Berghfer et al., 2020).

• Social: Destinys reason to abandon school and isolate herself from peers can be assessed to re-develop the desire in Destiny to join school and make new friends (Berghfer et al., 2020).

• Emotional: Emotional assessment is required to examine Destinys ability to control her emotions, cope up with stress and anxiety, to know how she reacts emotionally to different situations, to know the reason for her self-harm activities and suicidal attempts (Berghfer et al., 2020).

• Cognitive: Evaluation of Destinys cognitive ability will give clear picture of understanding of her mental condition & cognitive performance, about her IQ level, especially how serious she believes her mental health problems to be (Berghfer et al., 2020).

• Functional: Assessing her capacity for independent everyday tasks, such as self-care, household work, & academic work will give the clarity of her functionality on daily basis (Berghfer et al., 2020).

Specific mental health assessment tools & strategies-

• Eating disorder assessment: Eating disorders questionnaires is a popular self-report tool for determining the severity of signs of an eating disorder. It assesses habits like puking (vomiting, using laxatives), excessive eating, dietary restriction, malnutrition, body weight and shape concerns (Lev-Ari et al., 2021). In case of Destiny, this strategy will provide a better understanding of her poor eating habits, attitudes towards the food, her malnutrition score, etc. Given Destiny's history of severe eating disorder symptoms and malnutrition-related hospitalizations, this evaluation is essential to guide appropriate treatment to her.

• Self-harm assessment: Generalized anxiety disorder test and patient health questionnaire can measure the scale of anxiety and depression in a patient. These tests are essential as it enables physicians to monitor the development of symptoms, assess the effectiveness of treatment, and spot feelings of suicide in Destiny.

• Self-Harm Inventory test measures the frequency, methods, & severity of self-harm behaviours and Columbia-Suicide Severity Rating Scale analyses suicidal ideation. These evaluations are essential for risk assessment, safety planning, and choosing the right amounts of assistance and action for Destinys well-being (Kim et al., 2024).

• Family dynamics assessment: The Family Assessment Device (FAD) is a questionnaire designed to evaluate many aspects of family functioning, such as their behaviour with each other, communication, roles, responsibilities, support, financial status, family tree, family history, etc (Gonzlez & Rodrguez?Naranjo, 2023). To understand Destinys family dynamics, cohesiveness, adaptability, & dysfunctional areas, Destiny's all family members should participate in this assessment. This evaluation reveals opportunities for family therapy strategies and assists medical health experts in understanding that how interactions and bonds within the family may contribute to Destiny's mental health issues.

Feedback preparation:

• Collaborative approach: Throughout the assessment process, involvement of Destiny and her immediate family members in a collaborative manner is required for sharing decision-making & joint knowledge of the treatment (Tlli et al., 2020).

• Psychoeducation: Highlighting the areas that require support & strengths in order to give clear explanations of assessment results, psychoeducation is required (Tlli et al., 2020).

• Individualized feedback sessions: Organize separate session for Destiny feedback and combined feedback sessions with family as needed and encouraging candid communication between family members (Tlli et al., 2020).

• Goal Setting: Using evaluation results as a guide, jointly create short- and long-term objectives that are specific, reasonable, quantifiable, and time-bound for Destiny's fast recovery (Tlli et al., 2020).

4) Collaboration with Health and Social Services: The other health and social services that could help Destiny and her family to make their family dynamics better are CAHMS, Family therapy service providers, Paediatric and Adolescent Medicine, Community and Cultural Organizations, School environment, etc (Guide to CAMHS | Mental Health Services, n.d.). Collaboration with CAMHS to provide experts advice and appropriate personalized therapies for Destiny could increase her chances of fast recovery (Guide to CAMHS | Mental Health Services, n.d.). Adolescent-specific treatment support could show effective results for Destiny and her family. Coordinating with medical care therapists like paediatricians & specialists in adolescent medicine to manage Destiny's eating disorders and keeping an eye on her diet could help in physical well-being of the patient. Social workers can help in family togetherness and socio-economic difficulties by providing financial aid, food security programs, and public housing support etc to the needy family (Bland et al., 2021). Taking sessions with educational experts can help Destiny to reintegrate into a suitable learning school or institute that eventually helps her in advancing academically and improving her mental health. Family therapy sessions will be extremely helpful not only for Destiny but for her whole family. It helps in effective communication, settle down family quarrels, and reinforce the family support system. Being a part of any social or multicultural organizations can help Destiny to socialize, make new friends, and to learn social etiquettes which will help her to reduce self-harming activities (Bland et al., 2021).

5) Long-term & Short-term Consequences: The possible short-term and long-term consequences if comprehensive and appropriate support is not provided to Destiny and her family are as follows-
Short-Term Consequences: Due to Destinys severe eating disorder & self-harming behaviours, she faces immediate weight loss and critical health concerns if she does not receive medical assistance. This includes the possibility of more physical harm to herself or to others. Critical medical issues like malnutrition which could further leads to organ damage and an increased chance of suicide attempts can also occurs due to Destinys disturbed mental health (Knipe et al., 2022). Destiny's social & academic growth may be hampered due to her non-social behaviour and withdrawal from school. This seclusion could exacerbate depressive, useless & suicidal sentiments. The family's already fragile ties could go worse due to Jamal's mental health issues, Janet's history of trauma and her negligence for Destinys mental health. This friction in relationships may result in more arguments and separation of Destiny from her family members (Knipe et al., 2022).
Long-Term Consequences: Severe mental issues like major depressive disorder, eating issues, self-harm behaviour, isolation from family and friends may cause long-term mental health problems in adulthood, if left untreated in childhood or adolescence. If Destiny doesn't receive help timely, her physical and mental health gets worse and her academic performance might decline, which would eventually limit her options for employment in the future (Fett et al., 2020). This could create a low socio-economic status and make it more difficult for her to accomplish her goals, both personally & professionally. Due to heavy financial burdens, her mental health will get worse which might lead to more self-harm events and suicidal attempts. It is possible that the family with poor dynamics and history of persistent trauma could also affect upcoming generations. If Destiny fails to obtain proper assistance on time, it would be difficult to her in future to escape from her unfavourable habits & she might involuntarily pass on trauma & maladaptive behaviours to her subsequent offspring (Allswede et al., 2020).

6) Conclusion: Destiny's situation highlights how crucial it is to implement thorough and prompt personalized treatments for her. She runs serious risks to her life, psychological wellness, and physical well-being if she doesn't receive appropriate assistance timely. Major emotional instability for a long time, trouble in establishing new relationships or maintaining family relations, & repetitive self-harming nature could cause short-term & long-term severe consequences for Destiny. Encouraging resilience & rehabilitation requires addressing her family dynamics, offering specialized mental wellness care, and encouraging social & educational integration. Through emphasizing comprehensive strategies and co-operative endeavours throughout the healthcare, social, & academic domains, Destiny and her family could learn to support each other & would be able to effectively manage their family dynamics.

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