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Psychology input: building rapport with Jane and making her feel comfortable around therapists. Accepting that at this moment in time Jane may not feel ready to engage with therapies. Working with her and finding a way to help her re-engage with her support network and hobbies.

Investigating whether Jane requires assistance to support her with her partners care needs.

Addressing needs around pain management techniques and COPD.

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Investigating using readily available interventions such as pacing and gardening sessions to assist with mental wellbeing. Progressively start to build rebuild trust in therapies and rapport by engaging in tasks that are meaningful to Jane. Introduce mental health support very gradually. Arrange a meeting with multi-disciplinary team including psychology.

Asking the question as to whether Jane feels that she needs the support at home or whether she thinks this would benefit her. Discussing this sensitively and being mindful of Jane’s situation. Calling a MDT meeting to gain an insight as to what other professionals feel.

Progressively assisting Jane to engage in group-based interventions such as relaxation and pacing. Looking into mindfulness techniques and progressive muscle relaxation as an example and complete pacing chart using traffic light system. Allowing Jane opportunity to try a new routine. Encourage frequent breaks and rest periods.

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Actions/recommendations:

Getting support with husband’s medication, her own medication to make sure that Jane risks are minimised for potential overdoses. Respite from her caring duties.

Build therapeutic relationship with Jane through accessing gardening, art groups or volunteering at animal shelters and supporting her to engage.

Finding coping strategies for Jane possibly through art, talking or group therapy

Strengths:

Jane is aware of how alcohol has impacted her life and is proud of her sobriety.

Jane is proud of her home and achievements.

She is realistic with her expectations of meeting her responsibilities and occupational demands.

Jane does find satisfaction in tasks which can be explored further.

Her cognition is intact and her environment is positive.

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Immediate concern is her safety and suicidal ideation including access to husbands’ medication. Difficulties with identifying future goals, hopelessness.

Difficulties with building relationships, trust and being open about her difficulties.

No coping strategies

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1. Referral to social services for a care package for Brian.

(This will significantly benefit both of them, as Jean will be able to receive help with caring for Brian. This, in turn, will allow Jane to focus on her own health without worrying about accommodating Brian's needs (personal care, medication). She will have more time for her personal interests and activities and be able to maintain her role as a loving wife. Additionally, she will be able to complete her housework and maintain a healthy and happy relationship with her husband).

2. Jean to join an activity group of interest (gardening/ arts and crafts) Once a week, Jean to attend the activity group with her (support worker/ occupational therapist).

(Jean tends to feel more comfortable discussing her needs when she is engaged in some activity. By participating in activity she enjoys and being part of social groups, she will feel more at ease and build trust with her new support worker. This will also benefit her mental health, as she will spend time outside her home and doing things she enjoys).

3. Learning new strategies to manage energy levels- The 3Ps principle

(Just to highlight GP has already prescribed medication for her physical health which includes chronic pain and COPD)

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1. Home support/ carer for Brian

2. Low in mood/ activities/ building trust

3. Physical Health

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Pulmonary Rehabilitation - providing Jane with a program that includes exercise, education and mental health support to improve her physical endurance, reduce COPD symptoms and enhance her quality of life.

Self-Care Education - teaching and encouraging engagement in self-care strategies, such as good sleep hygiene, nutrition, and stress management could positively impact Jane’s mood and energy levels. Self-care could be incorporated into a daily routine as part of a Routine Establishment Intervention to provide structure and stability for Jane, even when she is low in mood.

Activity-Based Group Therapy - supporting Jane in attending a local voluntary gardening group, or a creative group activity that includes members suffering from similar conditions, to enhance social support and provide a sense of belonging to help improve her relationship building and overall mood.

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Problems with relationship building - Jane finds it difficult to trust others and build rapport due to previous negative and traumatic experiences, including being open with her husband about recent overdoses, community MH team and church friends.

Lack of motivation/hopelessness - During the assessment Jane disclosed that she has taken several overdoses of her husband's prescribed medication and she is feeling increasingly
hopeless about the future. Jane is committed to her current roles and in
maintaining these however was unable to identify any future goals.

Low energy - Generally Jane was able to pace herself during the task however she
explained that her energy can be affected by the chronic pain she experiences
and her COPD. At these times she will avoid task and becomes withdrawn.

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Invite Jane to 1:1 sessions with the MH team that include activities she enjoys participating in, to help build rapport and trust

Link with carers groups

Identify how often Jane is feeling low in mood, when did it start and did it become more prominent when she lost her job

Request consent from Jane to contact her GP to discuss management of chronic pain and COPD

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Forming therapeutic relationships with the Mental health team to promote engagement in interventions and assist in the development of trust. This will also encourage Jane to gradually seek support from those who can help or sign-post to other services.

Low mood

Chronic pain and COPD management

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· To teach Jane coping strategies to help regulate her emotions to prevent possibility of another

overdose attempt when low in mood.

· To discuss emotion cue cards to help Jane communicate her thoughts and feelings when struggling to

verbalise these.

· To build on trust and rapport with Jane through engaging in activities together that are meaningful to

her such as gardening session at her house. This will enable Jane to feel more comfortable and open

up more about her emotions as well as promote positive feelings eg pride and satisfaction.

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· Jane does not appear to have any sufficient coping strategies in place for when she is low in mood and lacking hope for future, resulting in

her overdosing on medication.

· Jane struggles to communicate when she is low in mood that has resulted in her overdosing on medication.

· Jane struggles to trust her care team and friends in her life which has prevented her seeking support when struggling with mood.

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Engaging (without assessing) in activities of interest to build relationship

Referral to GP for CBT or anti-depressant medication

Slow but active activities such as walking to work on both rapport building and grading/ pacing her activities.

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Building trust/ rapport with Jane

Jane's low mood

Jane's exhaustion