Case Study

Liang Wong is 42 years old and presenting to the mental health clinic after a hospitalization for an altered level of consciousness due to fentanyl poisoning. He has been cleared by the psychiatrist and referred to the clinic for follow-up. Mr. Wong has a past medical history of bipolar disorder, depression, a spinal cord injury leading to paraplegia in bilateral legs and a history of ethanol and fentanyl substance use disorder. Mr. Wong uses a power scooter for mobility.

As Mr. Wong’s nurse, you complete an initial assessment to identify Mr. Wong’s current needs and any resources that may be beneficial for him. When completing his assessment, Mr. Wong informs you that he has no permanent housing as he was living with his partner who broke up with him 2 weeks ago. Since then he has been living temporarily in shelters and on the streets. He was asked to leave a shelter due to his drug use, and he has been searching for another shelter. Mr. Wong states that he was coping well and was clean for 8-months prior to his partner breaking up with him and kicking him out of their apartment. You ask him about any additional familial and social support; he states that he has one brother and one sister, and both are uncomfortable with him living with them because they have young children. When asked how he financially supports himself, he states that he applied for disability support, however, received a denial letter about 3 months ago. He states that he was denied due to expired status documents that had to be renewed in addition to omitting a document from his family doctor, which he has been unable to acquire due to transportation issues. Additionally, Mr. Wong admits that he has not been taking his medications regularly or attending his narcotic support group meeting since the breakup. He states, “I was feeling depressed and embarrassed… I just need help now to get back on track”.

As you complete his assessment you highlight several needs for Mr. Wong and note his motivation to get better with the individualized support in place. In an interprofessional meeting, you collaborate with the physician and the social worker (SW) to coordinate a feasible plan of care. The SW suggests a detox shelter for Mr. Wong and also joining the clinic’s street health identification support program so that he can get the documents he needs to apply for the disability program. The SW finds Mr. Wong a nearby primary care provider and books his initial appointment. Mr. Wong states he is willing to go to detox and he will attend his follow-up appointments.

Mr. Wong visits the clinic for his one-month follow-up. You interview him to assess his current status. Mr. Wong states that he had a minor setback when he relapsed once in rehabilitation and had to go to the hospital to be medically cleared so that he could return to rehabilitation. He attended his primary care provider appointment and is continuing with his Opioid Agonist Treatment program.