Lira’s positive discharge story at Priory Barnt Green
When Lira* came to Clent Ward at Barnt Green, she was 22 years old with a diagnosis of emotionally unstable personality disorder, autism and ADHD. She had been in services since her teenage years and had been admitted to multiple units including acute, psychiatric intensive care units (PICUs) and low secure wards. She had become a ‘revolving door’ patient.
Risks and incidents
Lira’s main risks were self-harm (including cutting, ligaturing, head banging, insertion and swallowing), violence and aggression. Her most significant self-harm incidents resulted in multiple hospital visits requiring stitches and antibiotics. In some months she was having upwards of 10+ incidents a day, 80+ monthly, injuring herself and multiple staff, requiring strong wear and 5:1 observations. This level of acuity lasted for several months.
Therapy and engagement
At first, Lira declined to engage in all therapy and most occupational groups for a long time. It was known that she had a history of childhood trauma and unstable personal relationships but did not disclose details to any member of staff and only communicated with select nurses and healthcare assistants via written notes.
Positive behaviour support and least restrictive interventions
With the support of the team, Lira started to gradually build relationships. The team began slowly introducing PBS methods, such as giving Lira something to work towards and implementing restrictions when she couldn’t utilise items safely. We also began to take a more ‘step-back’ method during incidents, where safe to do so, focusing on verbal de-escalation and giving Lira the opportunity to self-regulate rather than immediate RRIT interventions. This was challenging and controversial to implement at first, with staff worrying about Lira’s safety, but eventually it resulted in fewer incidents of violence, aggression and self-harm. It allowed Lira to feel more confident in her own decisions.
Next steps and discharge
During her admission, multiple discharge options were considered for Lira. Initially, she did not engage enough for a personality disorder unit (PDU), and supported accommodation was not suitable due to her requiring long-term support and intervention. Eventually, after successful implementation of PBS techniques, gradual engagement with therapy, building of therapeutic relationships and a significant reduction in incidents and observation levels over the course of a year, for the first time ever Lira accepted that she wanted help and would like to go to a PDU. This took place 14 months after admission.
“I will forever be appreciative of everything you have done for me” – Lira
*Name and image changed to protect identity