Tomorrow will be my last day with the Community Mental Health Team, as my four week placement has now reached its end. This learning curve has been fabulous, but it is now time to return to my studies at university.
This week I attended the Clozaril Clinic, in which clients who are taking the anti-psychotic drug, Clozapine, regularly have their blood taken for monitoring of their white blood cell count. As a result of taking the drug, clients are at risk of developing neutropenia or agranulocytosis. This is when the white blood cell count gets low, and the person’s immune system consequently becomes compromised. In order for clients to remain healthy, it is therefore essential that those taking Clozapine regularly attend for testing.
In the first 18 weeks of starting Clozapine, clients should be tested every week, and then every fortnight for up to a year. Afterwards a monthly test is the usual requirement. The results of the blood tests are carefully scrutinised, and are awarded a rating of green, amber or red. A green result is absolutely fine, whereas a red result means that the medication should be stopped with immediate effect. An amber result will require another blood sample to be taken, and depending on the result, a decision will be made to either stop or continue with the medication.
Clients on Clozapine have to tolerate regular blood monitoring, because of the strong possibility of undesirable side-effects being present. These clients will be taking Clozapine specifically because other anti-psychotics have not suited them. Clozapine is one of the old atypical drugs, but it is still the best choice for a significant number of clients. The drug, Lithium, as commonly taken by clients who are bi-polar or manic depressive, is another medication where regular blood monitoring is an essential requirement. Regular Lithium clinics are also therefore held at the Community Mental Health Centre.
On another day this week, I went with the Occupational Therapist to take a lady shopping. The client has learning disabilities and is currently being assessed to determine her levels of independence and need. The shopping trip was to the local supermarket, which also has a clothes section. The client, the OT and my-self walked from the client’s place of residence to the shop. Along the way, the client was regularly observed to see how she coped with using the pedestrian crossings and negotiated general road-crossings.
At the shop, the client found that she had forgotten to bring her shopping list, but she was still fortunately able to remember what she needed to buy. The client chose some items of clothing and was aware of her size requirements. I helped her to find the correct sizes and she was reminded to keep her receipt, just in case later, they are found not to fit properly. The client also bought a few essential toiletries and then made her way to the till point, in order to pay. The OT carefully observed to see how she managed her handling of cash, and she did fairly well, except for not checking her change.
It was lovely to walk back with the lady and help her to negotiate the road-crossings once again. I was rather touched that she chose to link my arm and chatted to me a little as we made our way back to her home. Upon arriving, the OT reminded her to hold on to her receipt for the clothes items, just in case they needed to be changed. It was lovely to have done something useful, in order to have helped a person in need of some assistance. Upon arriving back at the office, the OT and my-self filled in the assessment form of how the client had coped with different aspects of the shopping trip and traffic awareness. On the whole, she had done rather well.