Specialist services case study
The case study of a resident with learning disabilities at the Priory Grange Potters Bar, Hadley Unit
James became a resident of the Hadley Unit at The Priory Grange Potters Bar on July 14th 2008 under Section 3 of the Mental Health Act (MHA) 1983. He had come from a more secure unit where he had been since May 2007 under the same section. His diagnosis was a mild learning disability with associated mental health issues of dissocial personality disorder, paranoid schizophrenia and multiple substance dependency. He also has a history of inappropriate sexual behaviour, absconding and non-compliance with treatment plans.
On admission, James was quite isolative only participating in conversation when he required something or when being spoken to. He preferred to stay in his own room only coming out to the communal areas for meal times. His appetite was good and generally complied with his medication. He was able to see to his own personal hygiene and understood the need for clean clothes. He expressed that he did not want to be here and was not happy. He did not want to join in any in-house activities. During these first few months, he continued to show this isolative behaviour.
This behaviour was discussed when James met with the multidisciplinary team (MDT). With the input from our psychiatrist, psychologist, primary nurse and other members of the MDT, it was noted that he tended to keep a lot of information locked up inside and would think many negative thoughts. It was clear the team needed to build up his confidence and low self-esteem and to try to develop a relationship of trust.
It was decided by the MDT that his medication could have been a cause to his isolative behaviour. Therefore, his doctor started to reduce his medication slowly. Another method of treatment utilised were 1:1 sessions with his primary nurse; this was to enable him to explore his needs using person centered planning. This treatment process gave him the opportunity to comply with his section 17 escorted community leave, to places and areas of interest to him. This encouraged him to engage with others, to help him create friendships and assisted him in learning to trust others. This behaviour was reinforced by the planned weekly activities conducted by the activities coordinator.
James became happier in his new environment, he started participating in cooking his own meals and showed that when out in the community he was confident with surroundings and showed good road awareness. As James became happier and more confident his main question was when he was going to be trusted enough to have unescorted leave. The MDT explained to James that this 'privilege' needed to be earned through him demonstrating he was motivated enough to achieve this goal by continuing to improve his behaviour. The MDT explained to him that by participating in activities, socialising more and thinking about how he presented himself whilst out in the community were all ways that would help him reach his goal of unescorted leave. James agreed with what was said to him, as he understood that his goal was achievable.
In November 2008, it was decided by the MDT that we would begin a shadowed leave period where he could go out for a particular amount of time and a member of staff would follow him so that he remained in their eyesight. This was a great achievement for James and he had proved to himself and the team that he could achieve this. We then observed great changes in his personality and social interaction. He began joining in with in-house activities, exercise groups, art and crafts, group outings and Christmas activities etc.
James continued to go from strength to strength and gained unescorted leave by mid November, which started at 45minutes. James also began to show great enthusiasm to use his unescorted leave wisely. He started using public transport to get about and showed confidence when doing this, and continued to meet with the MDT team to try to find ways in which he could control the negative thoughts he was still having, although he had expressed that he was having these less and less. Staff at the Hadley Unit encouraged James through praise to do more for himself, but still supported when needed. When James saw the positive response he was getting from staff it increased his self-esteem and gave him much greater confidence.
James' unescorted leave was proving to be a great success, he was going from strength to strength, participating well and happy to engage with others. James had requested to join a gym and agreed to start an in-house college programme. Subsequently, every time he met with the MDT team he was gaining extra time allocations for unescorted leave.
In December 2008, the MDT team decided to hold a tribunal in which supported community living was suggested for James. Although he is still detained under the Mental Health Act, a suitable supported living placement was found for him in February 2009. Thanks to the great work and rehabilitation given to James by the staff on the Hadley Unit at the Priory Grange Potters Bar, he is now much happier and in full cooperation, undertaking a trial period living in the local community.
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