Mental Health Concerns in Rehabilitation Case Scenario
Top Contributors - Ewa Jaraczewska, Jess Bell and Tarina van der Stockt
Introduction
This hypothetical case scenario demonstrates how a person's psychological state can influence their rehabilitation journey after injury. In cases of trauma, physical injuries can co-exist with psychological distress. Healthcare professionals must recognise that a comprehensive, holistic approach to rehabilitation includes restoring physical function and addressing the psychological impact of injuries and their causes.
This case scenario highlights how trauma-informed care, sensitivity to cultural and gender considerations, appropriate risk assessment, and multidisciplinary collaboration can create an environment that fosters physical and psychological recovery. It demonstrates the importance of recognising and addressing psychological barriers to rehabilitation, including pain catastrophising, low self-efficacy, and trauma responses.
Client Characteristics
Fatima is a 35-year-old woman who was admitted to hospital with injuries sustained from intimate partner violence. She presented with several psychological challenges that needed to be addressed alongside her physical rehabilitation. These included (1) high levels of pain catastrophising, (2) low self-efficacy and (3) discomfort with physical touch during therapy sessions.
Fatima's doctor recognised that Fatima was experiencing significant distress. He also recognised that, given the nature of her injuries (violence perpetrated by a male), Fatima might feel uncomfortable with a male healthcare provider. Because of this, he asked Fatima if she would like a female nurse to act as a chaperone during examinations, which Fatima accepted. This action improved Fatima's comfort and increased her trust in the doctor.
Examination Findings
The doctor approached Fatima's assessment with trauma-informed care principles. He clearly explained why it was necessary to conduct a physical examination, including touching near the site of her injuries. He obtained Fatima's informed consent before proceeding with the examination.
Because Fatima was displaying high levels of distress, the doctor conducted a brief risk assessment using the SAFE-T framework (Suicide Assessment Five-step Evaluation and Triage). While Fatima was not deemed to be at immediate risk for self-harm or suicide, the doctor acknowledged this was not his area of expertise and took three necessary actions:
- Documented concerns about Fatima's emotional well-being in a letter to her general practitioner
- Referred Fatima to the in-house psychology service for a more detailed risk assessment
- Maintained transparency by informing Fatima about these referrals, thereby preserving trust in the therapeutic relationship
Intervention
The doctor, working closely with the multidisciplinary team, implemented the following interventions to support Fatima's psychological needs.
Interprofessional communication: with Fatima's consent, the doctor discussed her case with other healthcare professionals involved in her care, ensuring a coordinated, trauma-informed approach across disciplines.
Social support mobilisation: the healthcare team contacted Fatima's extended family and invited them to spend time with her. This helped Fatima feel more comfortable in the hospital environment, improved her sleep quality due to her increased sense of safety, and provided her with emotional support.
Safety assurance: Fatima was assured that her partner would not be permitted to visit her in the hospital, establishing the healthcare setting as a safe space for recovery.
Evidence-based assessment: The Pain Catastrophising Scale was utilised to quantify Fatima's negative or catastrophising thought patterns related to pain.
Psychological interventions: Fatima worked with a psychologist who introduced Cognitive Behavioural Therapy (CBT) techniques. This helped Fatima address negative thought patterns and enhanced her self-efficacy.
Gender-sensitive care: when possible, all therapeutic interventions were conducted by female practitioners as per Fatima’s preferences. When female practitioners were unavailable, this was discussed with Fatima, and her consent was obtained for a male practitioner to be involved in her care.
Trauma-informed boundaries: Fatima was empowered to establish clear boundaries regarding physical contact during treatment, which was crucial for her engagement in rehabilitation.
Community resources and supports: Fatima was referred to local domestic violence support organisations, ensuring she had community support on her discharge.
Outcome
This integrated, trauma-informed approach resulted in positive outcomes for Fatima.
Reduced pain catastrophising: Fatima's score on the Pain Catastrophizing Scale quantifiably decreased. As her emotional distress and negative thoughts about pain decreased, her participation in rehabilitation increased and her pain levels decreased.
Enhanced self-efficacy: with encouragement and support, Fatima became more confident in her ability to perform rehabilitation exercises. This increased her adherence to her rehabilitation programme and improved her functional outcomes.
Increased trust in the healthcare team: this transparent, patient-centred approach strengthened the therapeutic relationship between Fatima and her healthcare providers, facilitating better communication and cooperation throughout treatment.
Effective multidisciplinary collaboration: because there was careful coordination between medical, psychological, rehabilitation and social support services, the healthcare team could address the many dimensions necessary for Fatima's recovery.
Patient empowerment: by respecting Fatima's preferences and boundaries, the healthcare team supported her autonomy and sense of control. These are important factors in psychological recovery from trauma.
Prevention of secondary traumatisation: the healthcare team's sensitive approach to Fatima's care helped prevent healthcare interactions from becoming sources of additional trauma or distress.
Conclusion
This case scenario demonstrates that when psychological support is integrated into rehabilitation programmes, patients can experience improvements in mental well-being. As their mental health improves, their capacity to engage with and benefit from physical rehabilitation interventions also improves.