Adam, a service user at the Priory Ticehurst House
Adam* was transferred to the Priory Ticehurst House under section 3 of the Mental Health Act with diagnoses of mild learning disability, borderline personality disorder, social phobia, severe self-harm issues and alcohol and drug dependency.
For years, Adam was in adolescent services due to the nature of his illness and his family had had no contact with him for a long time. At 18 years of age Adam was placed in adult services and had many admissions to hospital, in one year he had six acute admissions due to his chaotic behaviour. Adam was unable to cope in the community.
Now 27 years old, Adam was still in an acute setting under the Mental Health Act and was not engaging with the team. He also had a history of absconding to use alcohol and drugs. Priory was asked to assess Adam by his local PCT as he was still exhibiting the behaviours he had developed in his late teenage years. In addition, his self harm was becoming more severe.
Adam was assessed for admission to the intensive rehabilitation service at Ticehurst by the Lead Consultant and Nurse Assessor. His engagement at this time was minimal and he appeared to be reluctant to look at his issues. Adam was ambivalent about moving on down his care pathway and did not want to look at any kind of rehabilitation; his outlook for his own future was bleak. He did realise he had problems with drugs and alcohol and had self-medicated with these to help him deal with social phobia and anxiety issues. His self harm behaviours were evident on both arms, leaving them scarred and disfigured.
Adam came to the Priory Ticehurst House under a Section 3 and remained quite ambivalent about his admission to Ticehurst. At this time Adam voiced that he had given up all hope of having a ‘normal’ life.
Initially Adam remained pessimistic about his future and was reluctant to engage and discuss his issues. Nursing staff found it challenging to build a meaningful therapeutic relationship due to his mistrust of healthcare professionals, Adam stated that he had been let down many times in the past. On admission Adam was fully assessed by the multidisciplinary team (MDT) including a Psychiatrist, nursing staff, occupational therapists and a Psychologist for baseline. The MDT took some time to build trust due to Adam’s perception of past inpatient experiences.
Over time Adam started to attend dialectical behaviour therapy (DBT) sessions for his self-harm issues and was seen by the addiction therapy programme (ATP) therapist for motivational work and relapse prevention. He required weekly psychology sessions to look at how he could learn more constructive ways of dealing with his anxiety issues rather than resorting to self harm, social isolation and using harmful substances.
Adam slowly began to attend more activities as time progressed and the self harm eventually stopped altogether. He found that talking and being open about his anxiety and low self esteem helped him to take control of his negative feelings. Further, Adam never absconded during his time at the Priory Ticehurst House. He attributed this to feeling that he was far enough away from negative influences on his life, such as friends he made whilst he was using drugs and alcohol.
Adam was eventually taken off section as he stated that he would stay at the Priory Ticehurst House and adhere to treatment, which he did. He found that the team respected his views and positively encouraged him to take ownership of his care here and, with some assistance, help develop his own care plans. Adam’s activity attendance began to increase and he started to take more of an interest in his future.
Adam enrolled with the local college where he chose to do an English course, which he passed. Staff from the unit initially went to college with him to help him overcome his social phobia and to give him immediate support if he found he was not coping with the other students. The success of the college course increased his confidence and self esteem so Adam signed up for a painter and decorators course. He attended this course without assistance from the staff team and passed with a distinction.
At this point in his rehabilitation Adam felt that he wanted to make contact with his family and try to ‘build bridges’. Adam felt that this was important, he felt guilty about his actions previously and realised that his past behaviours had alienated his family as they were not able to cope.
The staff at the Priory Ticehurst House were able to assist with restoring the relationship with Adam’s family, which took some time to achieve. Initially the family began to visit Adam with supervision from the team and gradually encouraged him to have day leave, which built up to overnight leave. The relationship progressed to the point where Adam went on holiday with his mother, which was a huge success. During his time here the family got more involved with the care he received, with Adam’s consent.
Adam continued to improve and eventually felt comfortable with looking for accommodation in the community. He was very clear that he did not want to move back to the area he used to live as he had a great fear of re-engaging with people who would create a greater risk of relapsing. The MDT arranged a gradual move back to the community, which was at a pace that was comfortable for Adam. In addition, ongoing support from the local Community Mental Health Team (CMHT ) was arranged. Occupational therapy assessments of his living environment were undertaken and local support networks were sourced. Liaison with the local CMHT was essential to help Adam make the transition from hospital to the community as smooth as possible.
Adam was fully discharged to the community with CMHT support and is now happily settled within local employment.
* Please note, where necessary, the names used within case studies have been changed to protect confidentiality.