Ella - Newhouse Farm
Ella* was admitted to Newhouse in December 2009 from an out of county private residential service and previously to this she had lived at residential schools. She is a 31 year old lady whose contact with learning disability services began as a child when she attended a school that specialised in learning disabilities. Ella has diagnoses of an autistic spectrum disorder, learning disability and bipolar disorder. In the weeks leading up to her admission to Newhouse she experienced a deterioration in her mental health, which resulted in an increase in challenging behaviour and meant that her current placement were unable to manage the severity of behaviour that she was displaying. Therefore she was admitted to Newhouse as a formal patient under Section 2 of the Mental Health Act.
On admission Ella presented as manic mood, she found it very difficult to stay still. She has a greyish colour to her appearance and it had been reported that she had not had a full night’s sleep for a number of weeks. She was preoccupied with her continence pads, wanting to remove and throw them at staff.
Ella had a history of displaying self harm, most recently this had been in the form of pulling her hair out and head banging. At times when she appeared distressed she would hit out at staff and be destructive towards property. She was placed supportive observation-within arm’s length so that she could be closely monitored by staff.
She was assessed by our multi disciplinary team including psychology and occupational therapy. Her responsible clinician reviewed her medication and made several changes with immediate effect. Ella was prescribed a night sedative, with the hope that a regular sleep pattern would become established.
Contact was made with her family and they were brought into the service to meet our team and allow us to gather a complete understanding of her history and healthcare needs and work in collaboration as we developed a plan to support this lady to establish a better quality of life.
With the input of the multidisciplinary team, Ella made slow but steady progress. Staff who were allocated to her supportive observations made continuous efforts to engage her in activities. Initially this was through intensive interaction and short walks in the grounds. Staff on the unit were encouraged to follow routines that had been devised as Patient A responded well to consistency and appeared to benefit from predictability. A communication tool was devised to assist with her limited verbal communication. Our occupational therapy team re-engaged her with activities of daily living and she began to attend more structured therapy sessions such as art and crafts. Contact with the family continued to take place regularly. As progress was made we reduced her observation levels, reinstating them only as necessary.
A regular sleep pattern was established.
Ella, with the support of the team continued to progress, she discharged from section 2, 28 days after admission to Newhouse. She was by now on general observations within the service and had commenced social integration sessions. These periods of leave were supported by our OT team with staff support. As the risks were managed she eventually reduced from the support of 2 staff to 1 staff member.
A transition package was devised to meet her needs following consultation with the MDT, care manager and Ella's family.
Ella was discharged from Newhouse in March 2010, after a suitable less restrictive environment was identified by her Care Manager. This enabled her to return to her country of origin.
* Please note, where necessary, the names used within case studies have been changed to protect confidentiality.