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In my reflective account I will write about an individual I support who may show challenging behaviours. I will describe three development stages within the life cycle and I will include life experiences. I will use SPECC to talk about needs. The Data Protection Act 2018 states that disclosing personal information to third parties without a person's consent is unlawful, because of confidentiality I shall refer to this person as M.
M has been diagnosed with schizophrenia and is an alcoholic, he has alcohol related brain damage (ARBD) M has acquired this through long term drinking (Schwarzinger, M 2018) M was taken into care at a young age, this was due to his absence from school and getting into trouble with the police.
There were issues at home also, M's father was an alcoholic and his mother suffered from depression, there was constant arguing and sometimes m's father would hit his mother. M would witness these behaviours along with his siblings and most of the time they would have to take care of each other.
M was taken into care at the age of eleven, in care M suffered physical and sexual abuse by his carers. He would often abscond from the care home but would be brought back by the police. M once disclosed that he was being sexually abused to the police, but the police didn't listen and took M back to the care home .M took a certain dislike to the police and lost any trust in the authorities. M started hanging about with the wrong crowd, he started drinking and taking drugs and getting in trouble with the law.
M left care at the age of sixteen soon after M ended up in prison for stealing a car, M would be in and out of prison through his adult life for various criminal offences. M met the mother of his children during one of his visits, soon after his release he started a relationship. M had good events happen in his life, this would be the birth of his nine children. Because M was in and out of prison M struggled to form relationships with his children, and this has had an effect on his adult life.
M was brought into the health and social care setting when he was an older adult. M was unable to meet his basic needs; he would have no food or no money for electric or heating, his money was spent on alcohol. He was vulnerable to financial and physical abuse because others would be in and out of his home taking his money and causing him harm. He was often found in his own excrements and in a state of distress. He couldn't keep himself safe and he would call the emergency services saying he was being attacked by little people running around in his living room or that he was locked out his home. M could not recognise what was reality and what was not .M was detained under The Mental Health (Care and Treatment) (Scotland) Act 2003 for assessment it was decided M could not take care of himself or keep himself safe. And because M could not manage his money or make the best decisions about his welfare, M was placed under The Adult with Incapacity (Scotland) Act 2000. The act was one of the earliest pieces of legislation to be passed by the Scottish Parliament. It provides a framework for safeguarding the welfare and managing the finances of adults who lack capacity due to mental disorder or inability to communicate. In the past before the adult with incapacity act was passed M could have been placed in a mental hospital against his will, M has the right to a private and family life as stated in the Human Rights Act 1998(article 8), this means public authorities should not stop you living in your own home without good reason. And M has the right to live in his own home with support to make his own choices and be treated equal. The PANEL principle is put in place by including M in his care package, he is involved in all decisions that is made about how he chooses to live his life. I have a duty of care to keep M safe and to promote his independence.
Erik Erikson's (1959) theory of psychosocial development has eight distinct stages, taking in five stages up to the age of 18 years and three further stages beyond, well into adulthood.
During each stage, the person experiences a psychosocial crisis which could have a positive or negative outcome for personality development. For Erikson (1963), these crises are of a psychosocial nature because they involve psychological needs of the individual (i.e. psycho) conflicting with the needs of society (i.e. social).
it occurs during adolescence from about 12- 18years. During this stage, an adolescent search for a sense of self and personal identity, through an intense exploration of personal values, beliefs and goals. This is one of the first stages leading into adulthood, in this stage an adolescent experiences identity crisis, where they attempt to form their own identity and which path they are on. Failure to reach your identity can lead to role confusion this can lead to limited and bad choices. At this stage in M's life he experienced severe trauma through sexual abuse which has had a devastating impact on M life. His emotional needs were not being met he had no way of expressing his emotions, these should have been met by his family or care giver, but he had no emotional support from his family or carers. This stage in an adolescences life they would be attending school to learn and making friends and building relationships. M cognitive needs were not being met as he was truanting school, so he was not learning. M physical needs at this stage would be reaching puberty his body would be changing, but instead M was being sexually abused he was scared and confused about what was happening to him. The sexual abuse has been a very traumatic event in My life, which has contributed to his behaviours. The coping strategies he's used have been running away underage drinking and getting into trouble with the police at this stage Erik would say that m was going through an identity crisis and has a weak sense of will Impact M in the later stages as he will carry this crisis into to the next stage.
It occurs during young adulthood 18-40, at this stage a young adult will seek intimacy and form relationships with others. Intimacy for someone who has not dealt with the crisis from the stage before will find it hard to trust and form relationships. A person who has been abused may set up boundaries to stop others getting close and forming relationships with them or they may have no boundaries and let strangers close and may be easily taken advantage of. Without boundaries people who have been abused often end up in poor relationships which result in re-victimization (Davis 2000). During this stage in M's life he has not been able to form a healthy relationship, his relationship with the mother of his children was very volatile, there was a lot of violence which contributed to his time in prison. He didn't see his children often and when he did see them he would be under influence of alcohol which has affected his relationship with his children. At this stage in a person's life their social needs and cultural needs would be to have a job and hobbies, but M's social needs and cultural needs at this stage have not always been met because of his time in prison, M was isolated from society. Occasionally his cognitive needs were met because M would attend literacy classes in prison to learn this would improve his cognitive skills. But later in life M cognitive function would be damaged due to his drinking. By not meeting these needs a person can become isolated from others, unable to build healthy relationships which could lead to loneliness and depression.
This stage takes place during middle adulthood 40-65 years. This stage in a person's life they would be raising their family, doing well in their chosen job and being involved in their community. At the start of this stage in M's life, his safety and physical needs were not being met because he was being financially and physically abused he would have no money and was experiencing harm. Some of M's needs were met when he came into supported accommodation, he was safe in his home because staff would support M to gate keep, because of his guardian ship others can be refused entry if it was considered M would be at risk. He would have support to budget his money through access to funds, so M psycial needs were being met. M social needs have not been met, he finds it difficult to make friends or trust others, he has chosen to isolate himself from others and doesn't go out except when being supported by staff. He avoids any intimate contact also; this may be due to the conflict carried from earlier stages. It was at this stage in M's life that he was diagnosed with having ARBD, he was prescribed thiamine this will contribute to helping improve M's cognitive function.
Erikson (1968) suggest lack of intimacy may come from mistrust, role confusion and lack of identity, people who live a life of isolation find it hard to form relationships, which lead to loneliness.
Maslow's hierarchy of needs is a motivational theory in psychology comprising a five-tier model of human needs, often depicted as hierarchical levels within a pyramid. From the bottom of the hierarchy upwards, the needs are: physiological, safety, love and belonging, esteem and self-actualization. Needs lower down in the hierarchy must be satisfied before individuals can attend to needs higher up. (McLeod S 2018)
Humanistic Abraham Maslow believes we are motivated to achieve certain needs. According to Maslow needs are organised as a hierarchy, they can only be satisfied if the one below has already been achieved (Burton, N 2017). At the lowest level is basic needs food water sleep and shelter, once these are met we can move on to safety and security needs. As we move up our needs become more psychological and social, further up is the need for friendship, love and intimacy then there is need for personal esteem and feeling of accomplishment take precedence. Maslow emphasized the importance of self -actualization, which is process of growing and developing as a person to achieve individual potential. A person may move up the pyramid but may not stay there, they can move up and down the pyramid. I believe that M will not meet self-actualization, he is meeting his basic needs and safety needs but M struggles to form healthy relationships and his family are no longer in regular contact. M may not reach love and belonging because he finds it difficult to show his feelings, by showing his feelings M thinks this makes him look weak. M still drinks on occasion, this helps block out the abuse he suffered and cuts off his emotions, this has a huge impact on his cognitive functioning, he can become forgetful and be easily confused, which then can bring on challenging behaviours.
M was diagnosed with schizophrenia and an alcohol related brain damage. schizophrenia possibly could have been triggered by the trauma M suffered in his childhood. Schizophrenia is a brain disorder and has an effect on our mental wellbeing that causes disordered thoughts hallucinations and delusions. some chemicals in the brain behave differently for an individual who has schizophrenia, these are thought to be dopamine these chemicals help to carry messages between brain cells. An altered balance of these may cause symptoms. Treatments that can help schizophrenia can be talking treatment and antipsychotic medications, drinking alcohol can stop the antipsychotic medication from working. (ARBD) is a term to describe physical injury to the brain. M acquired this through long term drinking, he started drinking at very young age I believe M used drink to try and forget about the abuse that he suffered. Alcohol changes the structure and physical shape of the brain; these changes are a result of the toxic effects of alcohol and lack of Vitamin B1 (Thiamine). Vitamins deficiency is a common problem for individuals who drink Heavily and regular, alcohol stops the body absorbing some vitamins properly. Thiamine is an important brain nutrient, deficiency in thiamine can worsen ARBD, this can lead to Wernickes Encephalopathy and Korsakoff's Syndrome (Schwarzinger, M 2018). ARBD has had an impact on M's judgement, thought and cognitive memory. M can remember memories from the past but forgets what he has done earlier in the day. The damage to M brain has stopped the hippocampus structure of the brain record new memories, therefore M can't remember recent memories, so staff would support M to any appointments as he wouldn't remember any information the doctor has told him. We would record any appointments or important information in a diary for M. ARBD has also had an impact on M behaviours, M gets paranoid, agitated and can become verbally and physically aggressive towards others. And when M is not taking his antipsychotic medications this also will have an impact on his behaviours as he may experience disordered thoughts, hallucinate and delusions. This can be very challenging because M finds it difficult to work out what is real and what is not. There has been times M has given money to others and he will forget, he will then start to make allegations that someone has stolen from him or he can make allegations someone has been in his flat and assaulted him.
M is supported on a two to one basis because of his unpredictable behaviour, this was a protocol that was put in place when a risk assessment was carried out when M started drinking again. When supporting M along with my colleague one morning I noticed a change in his mood he seemed very agitated and annoyed. I sat down across from M so that we were face to face M prefers to be looking at a person when talking as he can become paranoid that staff are talking about him and not to him. I asked how he was feeling and he replied that he was fed up and felt he was being made a fool of by his social worker and thought he was stealing his money. He stated that his money was not in his account this morning. By this point M was talking in an aggressive manner to staff, I explained to M calmly that the reason his money isn't in his account is because that it didn't go in till after 11am now. M had forgotten about a conversation with his social worker about his money going into account after 11am. Even after explaining this it did not calm the situation, M was shouting and swearing at staff, myself and my colleague immediately left M's flat to give him time to calm down.This would be a method I would use in a situation like this ,de-escalation method is about removing yourself from any conflict, it can also bring a resolution to conflict. After five minutes M came down stairs and banged on door to be let out of building. I would record the incident in M care diary and record the incident on SHE (safety, health, environment) and I would also record it in staff communication book to make staff aware of M behaviours and there would be a conversation at the shift handover. Talking about the situation with others can be good for staff as it helps them to reflect on the situation and take advice from others. Situations can be draining make you feel down so I would also talk to my senior for support. This would also be spoken about at next team meeting and there may be a review of M care plan and risk assessment. My work place policy is to remove yourself from the situation, and if individuals become aggressive the police should be called. There is a zero tolerance to violence.
M could take a day or two to recover from this set back. He lacks resilience he finds it hard to cope with change and setbacks and this can often affect his behaviour and he will often use unhealthy defence mechanism. Resilience is about being able to bounce back from a negative situation. The development of resilience is the process of healthy human development, resilience gives people the strength to tackle problems head on and move on with their life. Rather than deal with a problem head on M will use unhealthy defence mechanisms, he will take his anger out on staff, his social worker and sometimes family, I believe this to be the reason family stay away as they struggle to cope with M illness.
Sigmund Freud believed the way a person behaves is because of past experiences and according to Freud the personality is made up of three parts, the id, ego and super ego. the id is part of the personality that demands, pursues gratification and pleasure. the ego aims to satisfy the demands of the id in a way that is socially acceptable, it understands reality and the super ego knows right from wrong it is the conscience. The ego employs a range of defence mechanisms to deal with conflict and problems in life and they help ward off unpleasant feelings. M uses the repression defence mechanism this is where he pushes unpleasant and disturbing thoughts and feelings from his past to the unconscious, by not dealing with this conflict this creates anxiety. And he will often use displacement defence mechanism this is where he will redirect his aggressive towards staff or other tenants this usually occurs when M has become confused and forgotten something due to his memory loss.
Children who have been abused often develop coping strategies or defence mechanisms to implement throughout their life as they progress through stages of development (Davis & Petretic-Jackson 2000). These coping mechanisms often affect how they interact with others
Alcohol and the brain,Alcohol Change UK [Online]
Cherry, K. (2018) Importance of Resilience,Coping with crisis [online]Available;
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