Part 1

As you answer the following questions, consider the needs of the client for a trusting, confidential relationship with the therapist and the needs of the families of the chronically mentally ill.

1. What guidelines would you establish to best meet the needs of the client?

2. What rights should parents, spouses, and children have to information concerning clients?

3. Who should be making the decisions concerning treatment options for chronically mentally ill patients who cannot make appropriate decisions for themselves?

4. If you were a therapist and a client made a decision that was definitely not in his or her best interest, how would you handle it?

John has not had any severe reactions, such as tardive dyskinesia, to the major tranquilizers. However, he is uncomfortable with many of the side effects. "I hate feeling doped up and spaced out. I'd rather hear the voices," he says. Several different major tranquilizers have been tried, and John states that he has had similar side effects with all of them. Without taking any of these medications, John has continually relapsed into psychotic episodes. During his previous hospitalizations John had agreed to take his medications, but he always stopped taking them within a few weeks of discharge.

5. If you were John's psychiatrist, what would you recommend?

6. Should clients be forced to comply with medical recommendations in order to be released from inpatient treatment facilities?

7. What about when clients are at risk of becoming a danger to themselves or others?

8. If you were a patient with a severe psychotic disorder and had negative reactions to medication, what treatment options would you want?

9. At what point do you think a client is unable to make treatment decisions?

During the second hospitalization, John's parents decided he needed a more structured living environment than they could provide for him. They explored group homes and assisted living facilities. Because John had a history of some violence, he was not a candidate for many of the nicer group homes. His parents could afford to place him in a private group home, however. John was discharged to a group home with five other male residents in their 20s and early 30s. All the residents of this group home were required to attend school or to work. The focus of the home was to help the residents learn independent living skills, which would enable them to live on their own some day.

John had been doing well living in the group home. He thought it was for the best that he not live with his parents. On discharge from the hospital, John had agreed to see Dr. Hersom for monthly medication checks and to attend group therapy at the local community mental health clinic. He was taking some vocational classes in computers at the local community college and doing some part-time yard work for a landscaping company. However, 6 months ago John quit taking his medication and once again experienced psychotic hallucinations and delusions. Late one night he was fighting his voices when he fell down a flight of stairs and broke his back, leaving him paralyzed from his waist down. He was in the hospital for 5 months.