Posted: April 20th, 2022

Assessment task 1A & 1B — Case Study — Maggie

No previous diagnosis
Assessment task 1A & 1B — Case Study — Maggie (Case Study and information is fictional) Mental health diagnosis (if relevant): No previous diagnosis
Client history:
Maggie has been referred by her GP due to concerns regarding mood and substance use._
Maggie presented to her GP because she has been having trouble sleeping.
Upon assessing Maggie’s recent mood and alcohol intake (daily standard drinks —6), the GP has recommended Maggie seeks support.
Maggie reports that she has been feeling ‘down’ for the past few months, especially since she had a fight with her dad. Maggies’ parents separated when Maggie was 12. Maggie reported that her relationship with her dad has always been strained, but for the past few years her dad has been seeing less and less of Maggie and her siblings. Maggie’s mum does not like to talk about her dad and becomes very upset when Maggie mentions him. The last time Maggie spoke to her dad, they had a fight about him spending less time with Maggies younger siblings. Maggie has not spoken to her dad since and does not feel like she is able to get support from her Mum. Maggie’s mum is also very distrustful of health services due to past experiences as an Aboriginal woman.
Maggie is enrolled in a vocational health course and works evenings in hospitality and up until now has enjoyed her study and her employment. Maggie reports that she is having trouble concentrating both during her classes and on the job because she is not sleeping well.
Maggie’s best friend was recently given a community sentence for drug related offences and is an inpatient at a drug rehabilitation facility. Maggie now feels she has lost her closest friend and support and has found herself consuming more alcohol to get through the day and to try to sleep at night. She finds the alcohol also really helps her mood. Maggie has also lost weight and she states that she is not eating.
Maggie reports she is becoming more and more withdrawn and feeling more and more lonely, because she does not want to talk to anyone about her mood and alcohol consumption.
Relevant medications: Maggie has expressed reluctance regarding mood regulating medication.
Risk to self or others: Nil at this point.
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There was no previous diagnosis.
1A & 1B Assessment Task — Case Study — Maggie (The case study and information are fictitious.) (If applicable) Mental health diagnosis: There was no previous diagnosis.
Client background:

Maggie has been referred by her GP due to concerns regarding mood and substance use._

Maggie presented to her GP because she has been having trouble sleeping.

Upon assessing Maggie’s recent mood and alcohol intake (daily standard drinks —6), the GP has recommended Maggie seeks support.

Maggie reports that she has been feeling ‘down’ for the past few months, especially since she had a fight with her dad. Maggies’ parents separated when Maggie was 12. Maggie reported that her relationship with her dad has always been strained, but for the past few years her dad has been seeing less

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