Summary
Molly Franklyn is a 21-year-old unemployed woman and is receiving
Newstart Allowance from Centrelink. Molly has recently dropped out of TAFE
where she was studying beauty therapy, stating that “life is just too hard
right now” and that she just can’t make things work. Molly has been treated
previously for Anorexia Nervosa and non-suicidal self-injuring (NSSI)
behaviours with little success.
Molly’s flatmates have always been very supportive of her but the recent
increase in Molly’s starving, purging, cutting and burning behaviours have
had a very negative impact on them both. As a result, they have decided to
ask Molly to move out of the flat. Molly has a recently broken up with her
boyfriend, so she can’t live with him. She has nowhere to go except home to
her parents who Molly describes as cold and controlling.
Molly presents as a pleasant, friendly girl who is happy to chat about
mundane things but becomes guarded to speaking about her health and
relationships.
Briefing for interviewer
Molly has been referred to hospital for assessment of her mental state and a
review of her current treatment plan by the local emergency department
following treatment for numerous NSSI lacerations and cold burns inflicted
on herself last night.
You are expected to interview Molly and undertake mental state exam and
clinical risk assessment for admission to the emotional disturbance unit.
You do not need to make a diagnosis or recommend investigations.
Context
Molly has a long history of NSSI involving cutting and burning with various
implements. Yesterday evening Molly became very distressed following a
therapy session with her counsellor, resulting in Molly cutting both her arms
extensively over an area extending from wrists to shoulders. Molly has also
burnt the skin over her left hand with an aerosol deodorant spray causing
thermal damage to the skin in that area. All of Molly’s wounds are bandaged.
Molly was taken to the hospital emergency department by her room mates
who were very distressed by the extent of her injuries.
On arrival at the ED Molly was placed in a cubical to wait for a doctor to
review her injuries. After 45 minutes a doctor appeared and reviewed Molly’s
lacerations and burn injury. Three of the 16 lacerations were closed with
staples; whilst two were closed with Steristrips (strips of tape applied to pull
the edges of a wound together).
Molly reports that the ED staff were dismissive and intolerant, choosing to
clean her wounds with alcohol wipes and applying anaesthetic to only the
most serious wounds before closing the edges with staples. Molly says this
as a common occurrence, stating that this has happened many times before
and that she has hidden wounds from hospital staff rather than have them
stapled without anaesthetic.
Molly has been referred to the mental health hospital with a view to
admission for a review of her mental state and treatment strategies.
Background and medical history
Molly has a long history of NSSI i.e. cutting with razors, broken glass, pen
knives, burning with cigarettes, lighters, oven hot plates, cold burns created
with aerosol propellants etc. requiring numerous visits to the hospital
emergency department for management of lacerations and burns to her
arms, legs, and abdomen.
Molly has gastro-oesophageal reflux, stomach ulcers, asthma. She has had a
broken ankle and crushed lumbar vertebrae which she sustained 7 months
ago during a suicide attempt.
Molly is currently taking antacid medication, multivitamins, food supplement
drinks to boost her nutrition, antidepressants with anxiolytic properties
taken to reduce stress levels, which increases her NSSI behaviours.
Anxiolytic medication reduces anxiety i.e. Cymbalta 120mg 2 x 60mg green
/ blue pellets – side effects experienced are gastric upset and dry mouth.
Social history
Molly shares a flat with two other girls, one a student nurse and the other a
waitress in a local restaurant. They have asked Molly to move out because of
her self-destructive behaviours.
She has dropped out of her TAFE course as she isn’t able to cope with the
pressure of study at present.
Molly is currently unemployed and is receiving Newstart Allowance from
Centrelink.