Client description
H.J is an 18-year-old African American male who was brought to the psychiatric clinic with complaints of suicidal ideations following the death of his close friend a few weeks ago. On further inquiry, it is noted that he has had multiple suicidal attempts since age 8-9 years old. He has been experiencing difficulty sleeping following abuse in childhood and thoughts of childhood trauma. He reports that the big sister is mentally retarded. His medical history is unremarkable, and he has no known drug allergies. Currently, he is on bedtime P.O sertraline 50mg for mood disturbance and 50mg diphenhydramine to aid him in sleeping.
Diagnosis and justification.
H.J has a major depressive disorder that is characterized by at least five depressive symptoms: present for at least two weeks and in which one of the symptoms is either depressed mood or diminished interest. From H. J’s description, he has been experiencing suicidal ideations and attempted suicide several times in the past since his childhood. Also, he experiences difficulty in sleeping at night, and he has preoccupations about his childhood trauma. The main factors that predisposed him to major depressive disorder are a history of childhood abuse, loss of a close friend, and the fact that his big sister has a history of mental illness (mentally retarded).
Legal and ethical implications during counseling.
Because H.J has suicidal ideations, legally, it would be appropriate to explain to the client that they need to be admitted until the suicidal ideations are no longer present to ensure the client is safe. Also, legally, it would be appropriate to inform the family of the current suicidal ideations for them to keep a close watch now and even in the future after discharge. Informed consent should be sought either from the client or family before the commencement of any interventions. During counseling, the patient’s autonomy should be observed, and the client has a right to decline to any treatment offered and are free to choose what they prefer after offering them other alternatives. In addition, the therapist should maintain the principle of beneficence as an intervention or treatment provided should be for the good of the patient for instance when it comes to prescribing medication, they should not prescribe a drug since the pharmaceutical company will reward them but because the drug will benefit the client. The therapist should accord respect to the client and humanely treat them. The therapist should uphold the principle of nonmaleficence, whereby they should not harm the client either physically or based on what they tell the client. Also, justice should be observed where the client is treated fairly with no discrimination or prejudice, and confidentiality should also be maintained, and only the persons entitled to know about the client. In this case, those taking care of the client and family should be informed since the client’s life is at risk. Lastly, the therapist should maintain their professionalism while interacting with the client and not judge the client.
Stockings, E., Degenhardt, L., Lee, Y. Y., Mihalopoulos, C., Liu, A., Hobbs, M., & Patton, G. (2015). Symptom screening scales for detecting the major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity, and diagnostic utility. Journal of affective disorders, 174, 447-463.
Hom, M. A., Podlogar, M. C., Stanley, I. H., & Joiner Jr, T. E. (2016). Ethical issues and practical challenges in suicide research. Crisis.
American Psychiatric Association. (2015). Depressive Disorders: DSM-5® Selections. American Psychiatric Pub.