Mental Health Nursing

This Clinical Report will allow you to apply your knowledge of mental health to demonstrate your understanding
of what is occurring with Dylan. The Clinical Report gives you an opportunity to evaluate Dylan?s situation
and make decisions about what you would do to help Dylan. The Clinical Report will provide the evidence for
your decisions in the MHCP (part 1).
SCENARIO: DYLAN CHOLLY
You are a Mental Health Nurse (MHN) in a General Practice office. Nineteen year old Dylan Cholly has been
referred to you by his G.P. Dr. John Alexander. Dr Alexander has been Dylan?s GP since birth and on the
referral he has given Dylan a provisional diagnosis of depression and expressed concern that Dylan may be
developing some paranoid ideation.
History:
As Dylan has been seeing Dr Alexander since birth you ascertain the following history from his file:
Dylan is an only child and has always been considered very bright, however always a bit shy. Although Dylan?s
mother has always ensured that he had yearly check-ups, there has been no significant medical history.
Dylan has been overweight from the age of three. At his last check up, 12 months ago, he weighed 140kgs.
However, Dr Alexander noted on his referral that Dylan has experienced a significant weight loss of 30kgs over
the past six months. There is no medical reason for this weight loss.
At age 14, Dylan?s best friend was injured by bullies while Dylan stood back not knowing what to do. Soon
afterwards he started having nightmares for which his mother brought him to see Dr Alexander. Dylan was
referred to a private psychologist. A report from the psychologist notes that Dylan attended three
appointments and then ceased contact because the nightmares stopped when he started attending another High
school.
Dylan arrives at his appointment with his mother, Kelly.
You notice that Dylan has long matted hair, is dressed entirely in black clothes that are too large for him
and is malodorous. He sits slumped in his chair and looks down at his feet for the majority of the
appointment.
Dylan is polite and softly spoken but only responds to your questions with short answers.
Dylan tells you that ?he feels fine? and he ?doesn?t understand why everyone is stressing?. When you ask why
he spends so long in his room he answers ?I can get everything I need from my computer but I have to be a bit
careful because they watch me and monitor my computer you know.?
Dylan denies suicidal ideation but says ?sometimes I wish I would just go to sleep and not wake up.?
When questioned about his future Dylan explains ?I don?t know what?s next for me at all. I know my marks from
school are good enough to do just about anything but I don?t want to do anything really, I just don?t care??..
I feel really lost.? You attempt to engage Dylan in further conversation about his future, his likes and
dislikes but he simply shrugs and says ?Dunno?.
It quickly becomes apparent that Dylan does not want to discuss anything further during this visit, so with
his permission you talk to Kelly.
Kelly shares that Dylan has limited social contact with others. Dylan defends his isolation to his mother by
stating that he has lots of friends who live in other places. Kelly also states that he spends long periods of
time on the internet.
Over the past six months Dylan has been spending extended periods of time in his room with the door locked and
he emails or texts his mother when he is hungry. Recently he has blacked out the windows in his room.
Dylan has never had a job.
Both Dylan?s s parents are working professionals and his father spends extended periods of time away from home
because of his job.
Dylan has never played organised sports. Kelly explained that she was concerned he might get hurt. While at
school Dylan did not have any significant social interactions outside of school hours. This became worse after
he persuaded his parents to let him return to his old high school six months after changing schools.
Kelly thinks he sleeps very little because she will often hear him moving around his bedroom late at night.
Kelly is very concerned about Dylan?s mental health as there is a strong family history of depressive illness  and Dylan?s maternal grandmother had depressive episodes most of her life. Dylan?s eldest cousin Brett
suicided almost 12 months ago when his wife left him.
During the time you spend speaking with Kelly, Dylan sits passively hands in his lap, head down, showing no  emotion.

 
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