David a service user at Newhouse Farm
David* is a 45 year old gentleman, who was admitted to Newhouse in July 2011. He was admitted to as an emergency admission following the breakdown of previous placement resulting from deterioration in mental health and behaviour. His previous placement was in a residential home but due to his deterioration in mental health and behaviour, staff at the home were no longer able to manage him and his care and as a result of this he was considered to be a danger to himself and others.
David has diagnoses of an autistic spectrum condition, obsessive compulsive disorder (OCD) and severe learning disability; he also suffers with recurrent Urinary Tract Infections (UTI). David is non verbal and relies upon the use of Makaton, and his own signs to communicate.
A phone call was received late afternoon from the referrer querying whether there was a bed was available at Newhouse. After a period of discussion, the placement was agreed. It was agreed that:
- Up to date assessments, care plans, risk assessments, communication tools will be provided to enable consistency to take place.
- A point of contact agreed to enable effective communication between previous placement, funding authority and Newhouse.
All staff on duty were informed of proposed admission, information regarding diagnosis, reason for admission and legal status of patient was shared with the staff team. David was admitted to Newhouse under Section 3 of the Mental Health Act. Over the next 48 hours David presented many challenges to the staff team at Newhouse, he would become increasingly frustrated if the staff supporting him did not fully understand what he was attempting to communicate. This would frequently result in the display of aggression towards staff and property. He was assessed by his Responsible Clinician, and a review of medication was conducted. A few changes were made with immediate effect.
Contact was made with David’s previous placement with regards to concerns regarding communication and the signs that he would use and outcomes of discussions were documented in his notes, to enable staff to become familiar with the communication styles that he utilises. Regular contact was also made with David’s mother between Newhouse and David over the phone.
Once the behaviours that David presented with on admission were analysed it was identified that a majority of the behaviours displayed resulted from obsessive behaviour and not knowing what was happening next or frustration due to barriers to communication. It was felt that he would benefit from a daily activity schedule that allows consistency to take place whilst promoting effective communication. A detailed schedule was devised and all staff understood the importance of consistency and structure and how this would hopefully benefit David. Following the implementation of the daily schedule David was able to start to develop therapeutic relationships with the staff team at Newhouse.
With the input from the multidisciplinary team David has made slow but steady progress, building therapeutic relationships with staff along the way. Over time interaction and participation in activities, therapies and section 17 leave have improved and the display of challenging behaviours had significantly reduced. There have been slight relapses in the behaviours presented but staff have identified these early, and therefore further deterioration was prevented.
David has been supported to maintain his physical health and has attended health appointments such as dental, opticians and chiropody when required; the nursing team has also liaised with GP regarding suspected UTI’s .
David was discharged from section four months after he was admitted to Newhouse and now resides on an informal basis. He is now on general observation and support levels whilst participating in social integration have reduced from the support of 2 staff to the support of 1 staff member.
He is currently working towards the completion of the Gateway Award-Bronze Level, has completed many OCN accredited courses. His participation in activities has increased and he will frequently request to participate in visits to local shops and walks. The staff team at Newhouse continue to maintain contact with David’s mother and he continues to phone her nightly. He is also supported to visit his mother on a fortnightly basis.
We are currently discussing the proposed discharge of David to a less restrictive environment and nearer his family with his care manager.
* Please note, where necessary, the names used within case studies have been changed to protect confidentiality.