Brad, aged 15 years, has been booked in by his father, Tim, to see the family GP for a general health check and review of his mental health.
Tim is a construction worker. Tim and his wife, Claire, separated about 11 years ago, and it was decided that Brad would live with his father, as he was always ‘difficult to handle’ and had ‘angry outbursts’, where he would throw things around. He visits Claire on some weekends, and she allows him to drink alcohol and smoke marijuana with her. Brad has had learning difficulties since primary school, and began attending a ‘special school’ in Grade 6 to address his learning difficulties and challenging behaviour. After attending several different primary schools and secondary schools he eventually dropped out of school in Year 8, aged 14 years, after being threatened with expulsion for his behaviour.
At the first consultation with the GP, Brad is reluctant to participate. The GP asks about his interests and manages to learn that he enjoys computer games, follows unpopular political leaders and dislikes the school system. He has no friends. At the end of the consult, the GP offers to call him on his mobile for a follow-up telehealth consult and encourages an open-door policy.
Brad does not return for several weeks, but meanwhile, Tim presents on several occasions following this initial appointment with Brad. Tim wants to be a good parent and get the right support for his son. In one appointment, Tim concedes that Brad has been violent towards him on several occasions but used no weapons. Brad also threatened to kill him on one occasion several months ago. Tim is often afraid for his own safety, and has set up his own escape strategy, which is to leave the house and ring the police.
The GP supports Tim with regular follow-up appointments and referrals for mental health support and support. A program at Berry Street (in consortia with other services), the Northern Healing and Recovery Program, has an adolescent family violence program that would provide support to Brad to address his behaviours. Tim might want to engage in two other Berry Street programs, the Matters program and their Teenage Aggression Responding Assertively workshop.
A couple of months later, Brad is brought in again by his father, who is becoming increasingly concerned for Brad’s mental health. Brad is feeling very depressed and suicidal and his angry outbursts have increased. He is increasingly threatening his father and throwing furniture around the house.
The GP makes referrals to the local youth mental health organisation and the mental health crisis team. However, Brad does not attend all of his appointments. He says he doesn’t want to speak to any more psychologists or psychiatrists, as he finds them to be unhelpful and feels that they don’t understand him.
One day the violence escalates so much that Tim has no choice but to call the police for protection. Following several such incidents, a referral is made to the juvenile court system.
The GP continues to offer support wherever possible and refers Brad to a paediatrician. The GP repeats a HEEADSSS screen to address any additional issues that might need to be addressed. Diagnoses of attention deficit hyperactivity disorder and Asperger syndrome are also queried.
Brad continues to return to the GP on an ad hoc basis, while the GP focuses on building trust and rapport in order to invest in a long-term therapeutic relationship. Appointments are kept flexible and last for at least 30 minutes so that consultations are not rushed. Telehealth is also utilised when appropriate but Brad does best when he comes in in person. A couple of years down the track, Brad has formed trust and a good rapport with the GP and has also started engaging with a psychologist more regularly. Tim is managing a bit better now and is able to recognise the warning signs and de-escalate the situation by prompting Brad with the appropriate advice from the psychologist to self-manage his outbursts. Calls to the police have not happened for a year. Tim continues to visit the GP fortnightly to seek support for his own mental health and coping strategies.