Scenario Analysis: Counseling a Patient Suffering from Depression and Suicidal Tendencies


Sam is a 42 years old male who was brought into the mental health unit by the police under section 22, after he physically threatened to hit his boss at work for firing him.  For the last several months, Sam has been showing up late for work, unable to complete his allocated duties, has been involved in verbal altercations with his workmates and was observed to sneak in alcohol and drink it at lunch time. His boss warned him to seek help for his problems otherwise he will lose his job. However, Sam always denied having a drinking problem and eventually was fired from work. On admission, Sam was irritable, argumentative, with slurred speech, poor judgement and his breath smelled of alcohol. Sam admits to consuming 3-4 drinks of alcohol every night when he comes back from his work.  He states “it relaxes me and makes me feel good”.    He has been drinking heavily for the last 2 weeks, almost half a bottle of whisky every night after his wife and children left him. In the past, his wife threatened to take the children and leave him if he did not stop drinking, but she did not leave because she felt obliged to keep the family together.  However, two weeks ago, she could not cope anymore and decided to leave. She was scared for the safety of herself and children due to Sam’s increased incidence of anger outbursts and physical threats. Whilst taking Sam’s family history, he stated “I’m like dad, we both love alcohol and there is nothing wrong in that”.  Upon further assessment, Sam reveals to you that his father used to shout and yell at him and he witnessed his father bashing his mother when he was drunk.   Sam reported that he had a poor relationship with his father as a child, he always felt insecure, threatened and scared. He grew up with constant worry, feelings of worthlessness, fear and guilt.  Sam revealed to you that he drinks alcohol to help him forget about his painful past and to cope with the stress he was having at work.  He also tells you that “I have been drinking heavily lately because I miss my wife and kids and I feel lonely and bored with my life”.   Whilst conducting a risk assessment, Sam expressed feelings of guilt, hopelessness and despair.  He tells you “I am a failure and no good for anyone...I lost my wife, my kids and my job....I wish I was dead”.

Using the above scenario, please address the following:

1.    Which DSM-IV TR criteria are indicative of Sam having a substance abuse disorder?
2.    Investigate the epidemiology of substance abuse disorder in Australia. You need to investigate the prevalence/incidences, possible causes, hospitalisation rates & burden of disease of substance abuse disorder.
3.    Examine the possible causes and psychodynamics behind the development of Sam’s disorder.
4.    Sam is experiencing multiple mental health issues.  In point form, identify 3 major problems or potential risks.
5.    Discuss nursing interventions in management of these mental problems or potential risks, include pharmaceutical and non-pharmaceutical interventions and reference to literature.
6.    Provide a rationale for each nursing intervention and reference to literature.


This is a scenario analysis about Sam, a 42 year old man who was admitted to a mental facility for beating his boss after being fired for drinking during office time several times in the past. Initial assessment reveals that Sam had a bad childhood and he is too much worried and has taken up alcohol. It has also been revealed that Sam is a case of acute depression and has suicidal tendencies. The questions related to Sam’s mental treatment have been answered in detail.

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