1) The document describes a case study of Client 8, a 78-year-old African American male with dementia who was involuntarily hospitalized after his home burned down and his wife perished in the fire. 2) Upon initial hospitalization, Client 8 was observed to be pleasant yet presented symptoms of dementia like impaired memory. A year and a half later, he continues to show dementia symptoms but is otherwise cooperative with his treatment plan. 3) Three main factors are preventing Client 8's discharge: allegations of arson, his ability to do daily activities, and the hospital treating him as mentally ill rather than for dementia. The document proposes alternative treatment plans to discharge Client 8 to a religious home and provide grief counseling.

1. Running head: CASE STUDY 1
Case Study
Ariel Ligowski
Liberty University

2. CASE STUDY 2
The Mental Health Division of the Public Defender Service of the District of Columbia
takes on clients that are emergency or involuntary patients at psychiatric wards in the district and
want to fight their status. As a social work intern, I assist my supervisor in meeting the clients’
case management needs, ensuring the client is efficiently equipped to be discharged into the
community.
Client 8 is a 78-year-old African-American male with dementia who is currently at a
psychiatric ward in D.C. In February of 2014, the client’s home burned down, and unfortunately
his wife perished within the fire. The client insisted on entering the condemned house to retrieve
personal items, and also presented with auditory hallucinations. Deemed mentally ill and a
danger to himself, the client was emergency hospitalized. As the client’s shirt had gasoline on it,
there has since been speculation on whether the incident was arson or due to a faulty stove.
Prior to the fire, the client was followed with out-patient services in the community for
psychosis, and has been on psychotropics in the past. Client 8 sustains himself with a pension
from an eighteen-year-long career at Brooks Brothers.
Upon hospitalization shortly after the incident, the client was observed to be pleasant and
cooperative. He was dapper and well-groomed, albeit underweight and possibly malnourished.
He maintained good eye contact, upheld appropriate affect, and maintained normal speech and
tone. The client denied symptoms of depression, mania or anxiety. He also denied suicidal,
violent, or homicidal behavior. He says he has heard voices in the past, but does not presently
hear any. The client failed his memory test, unable to remember presidents past Obama,
comment on 9/11, and name the months in backwards order. He was deemed to have intact
immediate recall, but impaired short-term and long-term memory.

3. CASE STUDY 3
Upon meeting him a year and a half later, in August of 2015, I found most of the past
observed behaviors of Client 8 to be upheld. His history at Brooks Brothers was evident in his
attire; he grooms and dresses himself, and does so impeccably, dressing in a fashionable suit.
Client 8 was endearing to meet with; he was polite, pleasant, and held an appropriate, even
cheery affect. He no longer appears underweight or malnourished. He is a religious man, being
noted by the ward staff for consistently reaching out to Client 3 (the subject of my previous case
study), who is difficult to engage, and reading the Bible with her. As he was upon
hospitalization, Client 8 was compliant with medications and is goal-oriented and cooperative
with his treatment plan. He is sociable and continuously participates in treatment programs and
small groups. He still presents symptoms of dementia-while he is currently moderately
functional, he has trouble getting out certain words. He is in the stage of dementia where he is
aware that he is fumbling his words, but cannot stop it.
Client 8’s current treatment plan would be simply executed if it weren’t for three factors:
the arson, activities of daily living, and the issue of mental illness. Client 8 is likable, compliant
with his medication, and cooperative with his treatment plan. However, he is able to do the major
five activities of daily living: feeding, toileting, bathing, walking, and grooming. Medicaid will
not pay for a nursing home unless he is unable to do at least one major activity of daily living;
this severely limits his housing options. The arson is also problematic. The allegation that Client
8 might have intended the fire raises a red flag for any housing agency, as they are liable if they
admit him and he causes another fire. Furthermore, Client 8 is estranged from his children; since
the fire and subsequent allegations of the client’s role, his children have withdrawn from him.
This eliminates the possibility of living with family. Finally, a factor that is interfering with this
treatment is the hospital’s allegation that he is mentally ill. Dementia is not a mental illness; it is

4. CASE STUDY 4
a cognitive disorder. Despite admitting he presents no psychotic symptoms, the hospital
continues to treat the client as if he has a mental illness. A psychiatric ward should not be the
home of a newly homeless man with dementia, yet, that has been Client 8’s life since February
of 2014.
Based on my education thus far from Liberty University’s School of Psychology, I would
not deem Client 8 mentally ill. He has no official diagnosis from his supposed psychiatric
history, while he does have an official diagnosis of dementia. In light of this, upon his
emergency hospitalization, I believe Client 8 was presenting with symptoms that are more likely
to be derivative of dementia than of mental illness. In abnormal psychology, problems in
memory and related cognitive processes are treated based on their origin: if the problems have
biological roots, the origin is delirium, major neurocognitive disorder, or mild neurocognitive
disorder. If the problems do not have biological roots, the origin is a dissociative disorder
(Comer, 2014).
According to Comer (2014), Client 8 meets the DSM criteria for mild neurocognitive
disorder due to Alzheimer’s disease, as he shows modest decline in memory and language
ability, cognitive deficits that do not interfere with independence, and gradual onset and
progression of cognitive impairment with memory and learning impairment as an early and
prominent feature. This is further upheld because these symptoms are not due to other types of
neurocognitive disorders or medical problems.
My preferred treatment plan would be to discharge Client 8 to the Little Sisters of the
Poor, Mother Theresa’s order in the district. As a Christian man, Client 8 reacted positively and
enthusiastically to being placed with the order. I would insist upon the nuns meeting Client 8, as
he is so likable, to make it an easier sell. I feel the Little Sisters of the Poor would be an

5. CASE STUDY 5
appropriate long-term setting for Client 8, as he can still take care of himself in basic ways, but
would need to have meals cooked for him. The Sisters are experienced in caring for individuals
with dementia, so I would not be concerned about his medical well-being. Finally, the religious
atmosphere would be fulfilling for Client 8, and probably provide a comfort as his dementia
inevitably progresses.
Furthermore, I would administer grief counseling for Client 8. As he has dementia, I
would not administer intensive psychotherapy; rather, I would want to provide counseling to give
Client 8 a space to talk about what he’s feeling and receive grief education. I might even utilize
the theory of explicit integration of Christian therapy, which dictates dealing with spiritual issues
in therapy by using spiritual resources such as prayer, Scripture, pastoral support, church small
groups, etc. (Tan, 2011). Having tangible resources like a passage of Scripture to refer to when
he struggles with a certain emotion could be effective for when he is confused. Through
counseling, I would hope to help him find healing from his wife’s death and children’s
withdrawal. If therapy reveals that Client 8 was complicit in some way in the fire, I would utilize
lay counseling to work through those issues, depending on what the situation deems fit. Finally,
it would be my hope to eventually involve Client 8’s children in his treatment plan, and possibly
administer family therapy. The children are valid in wanting to distance themselves from the
father after the death of their mother, as that is a tragic situation. However, I believe family
therapy could achieve healing for all parties, whether true reconciliation occurs or not.

6. CASE STUDY 6
References
Comer, R.J. (2014). Abnormal psychology. New York, NY: Worth Publishers.
Tan, S. (2011). Counseling and psychotherapy: A christian perspective. Grand Rapids,
Michigan: Baker Academic.