Area 9 - Physical Health Care


Due to the severity of her mental illness, Brenda has been cared for by other adults for most of her life. Tasks she normally would have learned to do herself were instead done for her by family members, B&C staff, care coordinators, hospital workers, etc. As a result, when Brenda needs to schedule an appointment with her PCP or other medical provider, she calls her mental health worker rather than calling the provider directly. This leads to confusion, misunderstandings, unnecessary back-and-forth calls, and delays in obtaining treatment.

Due to excessive anxiety and avoidance of situations that remind her of past trauma, Ramona is reluctant to go to a doctor and allow herself to be examined, or have any type of medical procedure done that involves someone touching her. As a result, she has not seen a PCP in nearly 7 years. This is a problem because Ramona has COPD and several other health conditions that need to be treated.

Due to disorganized thinking and paranoia, Dwight has not seen a PCP in the last 5-6 years. This is a problem because he reports having trouble with his vision, and given his age, he should be having routine screenings to prevent minor problems from escalating into more serious health issues.

Due lack of motivation and energy, Robert has not seen a dentist in over 10 years. Robert has severe periodontal disease and when he was last hospitalized, he was informed that he needed to see a dentist immediately. That was five months ago, and Robert has still not seen a dentist. When Robert was in the hospital, one of the doctors warned him that his dental condition, if left untreated, could lead to more serious health problems such as heart disease.

Clayton reports that he has been obese for many years and says his doctor recently warned him that he needed to lose weight. Due to paranoia and social anxiety, however, Clayton stays in his apartment most of the day, “eating to pass the time," and rarely ever getting any exercise. Clayton believes he would lose weight as his doctor directed if he got out of his apartment more, but social anxiety makes it challenging for him to engage in outside activities.

Lonnie cannot recall the last time he saw a PCP. He has been linked with a doctor at the L.A HOP program and was scheduled to see him several times, but due to lack of motivation, mild paranoia, and limited initiative, Lonnie did not show up for any of the appointments. This is a problem because Lonnie is a heavy smoker and would benefit from obtaining preventative and routine healthcare.

Everett has gained 40 lbs. since moving in with his parents. His PCP has warned him that his increased weight is exacerbating his back pain and putting him at risk of developing more serious health conditions such as hypertension, heart disease, and diabetes. Due to grandiose delusions, however, Everett believes that he himself is a doctor, and does not see any reason to listen to his PCP. "I trained him," says Everett.

Roland neglected treatment for his diabetes and HTN for years due to paranoia, delusions, and disorganized thinking. Since joining a new FSP, however, Roland has been linked with a PCP (nurse practitioner) whom he has begun seeing for treatment. Roland has not kept up with regular visits, however, and often runs out of his medications for diabetes and hypertension.

Due to reduced energy and motivation, and social withdrawal, Agnes remains in bed most of the day and gets no physical exercise at all. As a result, she has gained about 50 lbs. over the last year. This is a problem because Agnes has hypertension and the additional weight increases her blood pressure. It is also a problem because Agnes has chronic pain in her back and hips, and the additional weight has made the pain much worse. Agnes's PCP has warned her that she needs to lose at least some of the weight (20 to 30 lbs.) over the next year.

Due to lack of motivation and paranoia about physicians, Steven has not obtained routine medical care (such as a physical exam) in over 10 years. Because of the Steven's age (55) and recent history of alcohol abuse and malnutrition, he needs to have a routine physical exam, and is increasing his risk of developing more serious health problems by not getting one.

Due to lack of motivation and energy, and anxiety over what she may be told, Vanessa does not go and see her PCP on a regular basis. This is a problem because Vanessa has a number of health conditions that require consistent treatment.

Claude last saw his PCP about his Hepatitis 5 months ago. Due to impulsivity, trouble concentrating, and feelings of hopelessness, Claude has not followed up on aftercare recommendations. This is a problem because Claude’s conditions require ongoing monitoring and treatment.

Due to delusional thinking, William believes that angels are constantly with him and taking care of all his needs. As a result, William sees no need to visit a doctor, and only receives medical care when he is hospitalized for psychiatric reasons. This is a problem because at the age of 51, William should be having preventive health screenings on a regular basis, especially given his long-term use of alcohol and tobacco.


All PHI has been de-identified per HIPAA Privacy Rule