SHS 255-Co-Occurring Disorders
Case Study #2, due Nov. 18th

Read the case study and respond to the questions below.  Please word process your paper using 12 pt. font and double space.  Practice professional writing skills, e.g.  use correct grammar and punctuation, use objective and descriptive language and write concisely.

1.  Write 2-3 sentences describing the client demographically. (4 points)
2.  Identify the significant signs and symptoms of mental health/substance use issues.  (10 points)
3.  Discuss the strengths and resources the client has.  (6 points)
4.  Identify any medical, psychological or social risks the client faces.  (8 points)
5.  Review the SAMM  treatment strategy on pages130-136.  Discuss two skills the client is lacking that you could help her learn.  (8 points)
6.  Realizing there isn't enough info in the scenario to diagnose, what are your thoughts about the possibilities?  What section of the DSM IV-TR seems most likely?  (4 points)

Shannon is a well known homeless person in her neighborhood where she is typically seen walking or sitting in the park.  At times she will be gone for several months, and then she will return, looking healthier but still avoiding interactions with others and acting in a bizarre way at times.  For example, she sometimes gestures as if talking to others when no one is present and, although she has rarely acted out, there have been a few times when she has yelled at passers by for no apparent reason.

As a case manager doing outreach to homeless people with mental illness, you have tried on several occasions to engage Shannon to see if you could provide her with services.  She was polite but wary, suspicious of your motives and stating clearly that she didn't need anything.  She has smelled of alcohol on various occasions and you have seen her smoking marijuana two times.  On a couple of occasions she was extremely animated, excited and moving around quickly.  When you tried to ask too many questions she suddenly became angry and tense.

One day you encounter Shannon and learn that she has been assaulted.  She is conscious but disoriented, confused and hurts all over.  You get her to the emergency room and as she is being cared for you arrange to have her hospitalized based on being gravely disabled.  She goes through detoxification and is assessed for both substance-related  disorders and mental health.

Because you work for a really terrific program, you have the opportunity to work with Shannon and her co-occurrig disorders inpatient treatment team in preparation for discharge.  She has had group housing in the past, although she typically leaves because she doesn't get along well with others or she is evicted after discontinuing her medication and becoming uncooperative with staff and argumentative and hostile with other residents.  She has been encouraged to attend self help meetings, which she hates; she feels rejected, lonely and isolated there because others think she is odd and her hygiene is poor. 

As you get to know her, you come to understand that Shannon feels hopeless about ever having any kind of normal life; she has never felt suicidal but she'll be relieved when she no longer has to live in her tormented world.  She hardly ever experiences anything positive; on rare occasions she will visit her sister and that's okay for a while, but then she feels like she needs to leave so nothing bad happens.  She knows she should keep taking her medication; in fact, she's not even sure why she stops.  It seems like she just wakes up one day and everything is a mess again.