Clinical Scenario Billy Explained for Students (Easy Guide)

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Original Question

Clinical Scenario: “Billy” Billy is a 22-year-old British man who has been a patient on your mental health admissions ward for 2 weeks. This is his first admission to hospital and first contact with mental health services. Before admission he had been hearing voices telling him that the world was going to end soon but that if he didn’t leave the house and “waited for directions” he would be able to stop this happening. Billy was attending a local university where he was studying Philosophy and Politics, but abruptly stopped attending lectures a week before his admission and spending more and more time in his bedroom. When his parents asked him why he wasn’t attending lectures, he became irritable and did not offer an explanation, but would occasionally be seen laughing or crying for no apparent reason. After he had not left his room for 5 days and left most food and drink (placed by his parents on a tray outside his bedroom), his mother called the GP who came for a home visit and persuaded Billy to accompany her and his mother to A & E, after which he was persuaded to come into a mental health ward for assessment. On assessment, the following information was obtained: Billy believes he has been hearing the voice of Greta Thunberg, the environmental activist, who is giving him instructions which he needs to wait for. She has been speaking to him at night and telling him what he needs to do (e.g. self- isolate). He has been extremely concerned about locust plagues in Africa and the Middle East, and the climate emergency. He became vegan about 3 months ago, and hates the food on the ward as all they give him is salads, and the biscuits given out with tea and coffee are not vegan. Some of the staff seem to be confused about what veganism is and offer him cheese or eggs. There is never enough alternative milk to have in tea/coffee and put on his cereal. He says the water tastes funny. He drinks alcohol socially and smokes marijuana regularly (though not in front of his parents). He started hearing voices a few days before he stopped going to university. He has no underlying physical health problems, though looks very pale and thin, and blood tests revealed he has mild anaemia. Urinalysis showed his urine to have a high specific gravity and + ketones. Billy stopped eating yesterday and is now refusing to take his medication (olanzapine 10mg). It looks as if he might be hearing voices again as he is distractible and seems to be worried about something. He didn’t come to breakfast or lunch and appears to have lost some weight as his clothes are very loose on him. He hasn’t had a shower for 2 days and has to be persuaded to leave his room. Care Plan Template Need/problem/s Identified: Goal/s: Actions/Interventions: Evaluation: Sign (Patient): Sign (Nurse): Date: Date for review: Comments:

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