Bryan’s positive steps to greater independence
He stayed on Hillside Ward at Bristol Hospital for more than two years, before moving to supported living services in Wales.
Bryan reached his longest period of mental health stability on Hillside Ward. Better medication compliance, along with building trust, routines, and motivation, helped him manage his behaviour and stay stable. He stayed on Hillside Ward for more than two years, before moving to supported living services in Wales.
Bryan* was admitted to our male psychiatric intensive care unit (PICU) in after a mental health crisis at home that required emergency services. He was later moved to Hillside Ward due to his vulnerabilities putting him at risk in the PICU setting.
When he arrived, Bryan was 71, frail, showed signs of self-neglect, made little eye contact, and had trouble communicating. He was verbally aggressive, confrontational, and showed sexually inappropriate behaviour. Bryan has a long history of complex mental health issues, including bipolar disorder and schizoaffective disorder.
He does not have any active family or social support.
The challenges
Key difficulties included:
- Sexually inappropriate behaviours, such as making inappropriate remarks and exposing himself
- Racially motivated slurs and insults
- Poor balance and high falls risk
- Poor compliance with medication regime
- Lack of insight into mental health challenges
- Potentially undiagnosed neurodiversity
- Disordered thinking, speech, and comprehension issues, including dysarthria, a strong accent, and increased agitation when asked to repeat himself
Our approach
- Holistic MDT-led care
- Weekly GP visits for physical health
- Consistent therapy input (occupational therapy and physiotherapy)
Occupational therapy input
Our occupational therapist worked to build trust, set routines, and establish clear behavioural boundaries to help Bryan engage and reduce risk. Bryan responded well to predictable routines, consistent staff interactions, and clear expectations, which were explained both verbally and in writing, to help with his communication challenges.
Considered within clinical reasoning, informing the use of routine, consistency and social modelling. Functional occupational therapy input supported activities of daily living, including managing finances, online shopping for clothing, and access to meaningful routines such as receiving a daily newspaper.
A key goal was safe community access. Initially, Bryan displayed socially inappropriate behaviour when out in public. The occupational therapist used graded exposure and social modelling to teach appropriate social behaviour, with expectations discussed and agreed before each outing.
Over time, Bryan’s behaviour significantly improved, enabling community engagement with minimal incidents.
Leave and autonomy
Following a sustained period of settled behaviour on the ward and during escorted access to the grounds, Bryan expressed motivation to progress to unescorted Section 17 leave.
Initially, he was discreetly observed; however, he quickly demonstrated safe and appropriate use of his leave and was able to access the hospital grounds independently.
Bryan routinely visited the main building to engage with the wider staff team and access the vending machines, taking clear pride in his developing independence and using it responsibly. Bryan also represented himself well at tribunal and during a managers’ hearing, where he effectively advocated for himself when contesting his section.
Nursing team input
- Daily risk monitoring and documentation
- Care planning, risk assessment and review
- Monitoring his physical health needs (nutritional, dental, oral and optician) supported by the GP
- Implementing de escalation and communication strategies
- Ensuring environmental safety
- Supporting medication adherence and reporting to the medical team any challenges
- Providing consistent boundaries
MDT input
- Consistent approach to boundaries as a team
- Trauma informed, person centred care, considering Bryan’s background
- Prompt reporting of incidents or deterioration
- Maintaining dignity and safety for Bryan and all patients
The journey
Bryan reached his longest period of mental health stability on Hillside Ward. Better medication compliance, along with building trust, routines, and motivation, helped him manage his behaviour and stay stable. He stayed on Hillside Ward for more than two years, before moving to supported living services in Wales.
*Name and image has been changed to protect identity