Case study: Juho is a 45-year-old male who is living with chronic paranoid schizophrenia. Juho was born in Finland and was brought to Australia as a boy by his parents, who migrated here for work.

Assessment 2 Appendix 1: Case Study

CASE STUDY

Juho is a 45-year-old male who is living with chronic paranoid schizophrenia. Juho was born in Finland and was brought to Australia as a boy by his parents, who migrated here for work. Juho speaks fluent English but often reverts to speaking in Finnish, which he spoke at home while growing up. Juho has a sister, who is married and lives in town. She is worried about her brother but has "given up" as it is "all too hard".

Juho's condition has been generally stabilised on a fortnightly, long-acting injection of Risperdal Consta. Juho requires an order under the Mental Health Act to ensure he continues to take the injection each fortnight. Juho also has a Community Mental Health Case Manager, a mental health nurse who is keen to support Juho within a recovery-oriented framework.

Although Juho has been stabilised on his medication, he continues to hear voices. There are two voices, both are located outside his head, and they are derogatory, telling him he is "no good", "good for nothing" and "everyone hates you". On occasion, they also tell him to kill himself. These voices are constant and sometimes quite loud. Juho tells his Case Manager that the voices upset him. He says the fortnightly injection helps to reduce the volume of the voices, but he is not committed to having the injection regularly because he "hates needles" and in his opinion, the alcohol (vodka) he consumes "works just as well". Juho would much prefer it if the Mental Health Service provided him with free vodka rather than "those damned needles".

Juho also has problems with his self-care, often neglecting to shower and eat. He says this doesn't worry him and he's not sure why it should worry anyone else. But most concerning of all for his Community Mental Health Case Manager is the fact that Juho sleeps on a bench seat in a park in town. The Case Manager spends much time and energy trying to convince Juho to sleep where he lives in his bed as there have been complaints from members of the community that he mutters to himself and scares them.

But Juho tells his Case Manager that he likes to sleep on the park bench, sleeping outside is part of his cultural heritage. Sometimes he dives naked into the pond, in the middle of winter, because he's heard that's what they do in Finland, and this is part of who he is. He also likes the feeling of freedom the park gives him; the voices don't worry him so much when there is plenty of space around him.

Juho goes on to say that he doesn't feel safe in the house where he lives as there are some "bad people" there. In contrast, Juho says the ducks are his friends and "look out for him". Juho says he can't understand the complaints that have been made about him by the community because he's not hurting anyone. He doesn't like people very much and always keeps to himself. However, the Case Manager knows this is not true as Juho has a history of assaulting people, leading to several long stays in an acute mental health facility. Juho insists he only did this to protect himself from others, but his paranoia makes it difficult for the Case Manager to determine if he was being attacked or only thought he was being attacked.

One day, when Juho's Case Manager visits him in the park, he noticed that Juho seems unable to use one of his arms and has a number of bruises on his face and arms. Additionally, his head seems to be slightly twisted and it is difficult to understand what he is saying. Juho tells his Case Manager that it is "nothing" and he refuses to go to hospital for a medical assessment.

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