CASE STUDY: Mr. Jim Jones
Client Name: Mr. Jones Date of Evaluation: 9/30/99
I. Reason for admission (chief complaint) as stated by client, family and/or referring agency:
“The Sheriff’s Department injected me with germ warfare causing these sores.
II. History of Present Illness:
Mr. Jones is a 48-year-old African-American male who was referred to the Smithville Assertive Community Treatment team (SACT) for after-care following his release from Smithville State Hospital due to his diagnosis of
Schizophrenia, Paranoid type. Mr. Jones presents as an extremely resilient and resourceful individual. He has managed to survive on his own despite significant barriers to his well-being which include: severe poverty, homelessness, a past history of numerous traumatic experiences, lack of social supports, substance abuse dependence, a long history of acute psychiatric hospitalizations, persistent recurring symptoms, and a history of involvement with the criminal justice
system. Mr. Jones has managed to survive in the community by living on only $509 dollars a month, retrieving food out of garbage cans and securing intermittent housing in “dive apartments.” He has attempted to control his symptoms through the use of alcohol and illegal substances and
states that psychiatric medications have not worked well for him. Through his experiences he has developed a severe mistrust of the legal system and psychiatric treatment system. His ability to survive despite these circumstances is a testament to his tenacity and intense desire to remain
independent. Mr. Jones states that his current goals are to: (1) live by himself in Smithville, (2) eat three meals a day, (3) find a doctor to get rid of the germs that the Smithsville County Sheriff’s Department injected him with, (4) not go back to jail or the hospital, (5) get a job, and (6) develop a relationship with someone he can trust. Previous Smithville State Hospital records indicated that he was released from a maximum-security forensic unit (release date 8/27/99) after being
found incompetent to stand trial for alleged felony assault. He was transferred to Smithville State Hospital for treatment and released on 9/29/99. Mr. Jones was admitted to Smithville State Hospital Forensic Unit in July 1988 after facing charges of aggravated assault. Jones states that, while on the forensic unit, he made suicidal gestures, such as slashing his neck with
a razor blade due to auditory hallucinations. He reported attempting to commit suicide five or six times in jail by slicing his arms with sharp instruments, sticking pins into electrical outlets, overdosing on pills, jumping off things, and setting himself on fire. The client’s first encounter with the legal system occurred in 1975, when he shot a friend in self-defense. After that time, he began to drink heavily and use street drugs. He served time in the Mississippi Department of
Correction in 1976 for robbery and again in 1984 for aggravated assault. While in prison for aggravated assault, he was diagnosed with schizophrenia and placed on Haldol and Sinequan. He reported a good response to Haldol and was described as quiet and cooperative. He is afraid of what might happen if he goes to prison again, and believes that the Mississippi syndicate has a contract out on him for $10,000.
The Smithville Police Department records from 6/8/98 indicate that Jones was threatening to cut people with a knife at his apartment. He was found to have three outstanding warrants. Police noticed a strong odor of alcohol. Jones attacked the officers. He was not affected by pepper mace. After being handcuffed, Jones stated that police were going to burn in a volcano and that he was going to light the fire. Correctional Medical Services notes from August 1998 indicate Jones was
treated with Haldol for schizophrenia, but had been refusing medications. He states that psychiatric medications have been ineffective in the past. His records show he is unable to maintain a structured medication regimen due to a lack of social and structural supports. He is described as experiencing acute symptoms as evidenced by his constant talk about Jesus and devils. He complains about vampires. He refused antibiotics for his impetigo. A letter from Dr. Hidalo (who saw Jones 10/98) describes Jones as “extremely labile and frequently quite hostile.” He was loud and demanding. He had improved after a recent hospitalization during which he received Haldol, but again decompensated. He was religiously
preoccupied and delusional. A court order from 11/9/98 indicates that a jury found him unable to stand trial due to his symptoms and he was subsequently committed to Smithville State Hospital. A report from Smithville County Jail indicates that Jones was treated with Haldol and Cogentin for paranoid schizophrenia that is complicated by him not taking his
medications in the prescribed manner. The jail indicates that Jones is “very unpredictable and goes through mood swings. He exhibits paranoia and is delusional at times. He thinks that he is Christ and will accuse others of
being the devil. He picks hair out of his head and beard and has little round areas of pink skin where he no longer has any hair. He can be aggressive and a couple of days ago, he tried to hit a nurse with his fist. He does not like to wear clothes.”
Service system records indicate numerous previous psychiatric
hospitalizations, including five admissions to the State Hospital and fourteen to Morgan Medical Center. He has been offered outpatient treatment since 1992. Other past diagnosis includes Psychotic D/O, NOS, Organic Hallucinosis, Adjustment Disorder and Undifferentiated Schizophrenia. He states “I was charged with murder in 1976, but all I did was pull the
trigger.” He reports that he had AIDS (a delusion) and stomach viruses from drinking out of toilets. He has 19 past admissions but only four of them longer than two weeks. When asked about substance abuse, he states “I can’t get them enough. They make the angels and devils stop talking to me.” He has numerous self-inflicted scars on his arms. He reports that he hears and is Jesus Christ. He believes that he has bugs crawling inside and outside of his body. He also believes that staff has tried to kill him in the past. Mr. Jones reports that he is a victim of a conspiracy involving Satan and the Smithville County Sheriff’s Department to infect him with germ warfare. He states that he hears voices of the devil and the Holy Spirit. He reports that this occurs all the time and that he is not bothered by these experiences. He states that the voice says “stick ice picks in my eye and I’m going to eat you in the microwave.” He becomes agitated when discussing these voices in detail because he believes they are real and is
fearful of retribution from “the devil.” He denies any symptoms of depression but reports two previous suicide attempts by cutting his forearm. He states that he has not been suicidal in many years. He denies any symptoms of mania, panic attacks, or memory impairment. Recently he reports that he is doing poorly, which he attributes to being infected with germ warfare.
in APA, Discuss TWO specific treatment components of ACT that apply in the case of Mr. Jones, and write about how you would implement them.
What symptoms of Mr. Jones are targets for ACT?
Refer to the reading :
https://moodle.adelphi.edu/mod/resource/view.php?id=4698345