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Mike is a 21-year-old male who presented in Emergency Department (ED) with thoughts of self-harm, agitation and insomnia. He was brought in by his flatmate who is a student nurse, who had noticed the changes in his mental health. He has not been sleeping well and gained weight over the last two years. Mike has moved from Melbourne to Sydney to study engineering at university. After two years of working part-time at Kmart, he was given the opportunity to supervise some of his co-workers. This is a new role and Mike found this to be very challenging, particularly as he is required to supervise a crew. He wants to show his supervisors that he can do the job. When he arrived in the ED, he was agitated, had minimal eye contact, was disinterested in engaging and would only engage with selected nurses. Lately, he has been having trouble sleeping. A GP from a medical centre prescribed Temazepam 20mg nocte. He also started taking Phenergan 10mg to help him sleep. He has previously taken Phenergan for his allergies which he can buy from the chemist without a prescription. He thought this might help with his sleepless nights. He has been watching shows on his iPad in bed at night, in the hope that it would help him go to sleep. The medications did not help and instead, he stated that it kept him awake at night. He started smoking marijuana to help manage his insomnia with very little effect. He stated that he has intermittent sleep and has not slept properly for 6 days. Mike remembers when he first started having difficulty sleeping. Mike experienced severe bullying during his high school years. His classmates would often corner him, taunt him, and sometimes physically assault him. One day, while working, he overheard a group of colleagues making disparaging comments about another employee. The tone and nature of the conversation immediately brought him back to his high school years. Mike explained that he felt his chest tighten, pulse quicken, and nauseous. He excused himself from the conversation and rushed outside to calm down. The feelings of fear, shame, and helplessness were overwhelming; as if he was reliving the bullying all over again. That night, Mike struggled to sleep, his mind replaying the bullying incidents from his childhood. He often avoided social gatherings and team-building events at work, fearing that similar situations would trigger his PTSD. These episodes affected his ability to form close relationships with his colleagues and left him feeling isolated and anxious. Mike has been supported by his GP and a private psychologist since he was 18 years old when he was first diagnosed with anxiety. However, since he moved to Sydney, he has not found a GP in Sydney that he can trust. He continues to be on Fluoxetine 20mg daily but feels that he needs it reviewed because of his low mood. He voiced that his long-term goal is to cease the medication as ‘this is the one thing that would make me feel like I have recovered’. He expressed that he is not ready to stop his medications. Mike admitted that he previously had thoughts of harming himself by crashing his car. This was the reason his GP commenced him on Fluoxetine and Mike started seeing a psychologist who helped him with his self-harm thoughts. However, these self-harm thoughts and feelings are starting to return, and he does not want these thoughts to consume his life again. He does not have any family in Sydney. He is reluctant to tell his family in Melbourne about the changes in his mental health. They do not know that he is on medications for his anxiety. He stated that although his family are very supportive, he did not want to burden them with his problems. He knows that his mother would want him to go back to Melbourne. He said that going back home would make him feel like he failed. He stated to one of the nurses ‘I am an adult and not a child anymore’. Mike started to feel inadequate, constantly second-guessing himself and was irritable at work. He also started to gain weight since he started on Fluoxetine. He does not have the time nor the energy to exercise due to work and study. He really wants to lose weight and go back to his ideal weight to play football again. But he feels unmotivated at the moment due to his mood. He is too scared to go to the Employee Assistance Program (EAP) at work and does not want to let his supervisors know. He does not want to be seen as incompetent in his new role as a shift supervisor. Step 3: Scenario You are a team of Registered Nurses working in an emergency department. During the morning handover, you are to discuss how your team can advocate for one of your patients named Mike to be assessed by the mental health Clinical Nurse Consultant. Each member of your team is an expert in a variety of topics pertaining to developing therapeutic relationships concerning mental illness or mental ill-health.

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