There was a marked reduction in both the frequency and severity of Patient A's risk behaviours. They became increasingly calm and settled for prolonged periods, while their engagement and functional independence improved. A bespoke community placement was identified, and a deliberately prolonged and cautious transition was undertaken to support a sustainable move.
Patient A was admitted to Pankhurst Ward having already experienced several ward closures and, alongside their autism spectrum condition (ASC) and a significant history of trauma and abuse, this contributed to considerable difficulty trusting staff and building relationships. They repeatedly questioned why they should engage with a team when previous placements had ended.
On Pankhurst Ward, they presented with significant behaviours that challenged, including violence and aggression towards staff and peers, property damage and self-harm through head banging, ligatures, ingestion of foreign objects and cutting. Escalation meetings with the referring team concluded that a PICU environment was not conducive to their recovery.
A consistent, carefully considered approach was introduced, supported by a positive behavioural support (PBS) practitioner who worked directly with Patient A and role-modelled engagement for staff in real time. The multidisciplinary team (MDT) developed an autism-informed model of care built around predictable routines, clear and consistent boundaries, positive behavioural support, psychological formulation, occupational therapy and careful consideration of communication when Patient A became distressed.
Staff were encouraged to use reassurance and de-escalation rather than inadvertently escalating confrontations around boundaries. Weekly reflective practice, enhanced team training and joint sessions involving psychology, PBS and the RRIT team helped staff understand Patient A's formulation, manage risk consistently and recognise potential transition triggers.
As trust developed, Patient A began engaging in a wide range of activities with observing staff, including games, clay art and physical activity. Their interests were incorporated into their environment and timetable, including a Lilo and Stitch theme, helping create a more personalised and engaging space. They also benefited from pet therapy and found having their hair braided an appropriate and enjoyable form of therapeutic touch.
Occupational therapy supported their development of everyday living skills and community access. Patient A progressed from needing considerable encouragement with basic tasks to independently completing their laundry. Her Section 17 leave gradually expanded from the hospital grounds to shops, parks, a farm, Blackpool and other community settings. Successful community visits provided important evidence that their risks could be safely managed outside hospital.
There was a marked reduction in both the frequency and severity of Patient A's risk behaviours. They became increasingly calm and settled for prolonged periods, while their engagement and functional independence improved. A bespoke community placement was identified, and a deliberately prolonged and cautious transition was undertaken to support a sustainable move.
The combination of a lower-stimulus environment, consistent relational care, psychological and behavioural formulation, medication, occupational rehabilitation and graded transition resulted in a substantial and sustained reduction in acute risk.
Patient A continues to want to build towards engaging with others. While their insight remains limited, they respond warmly when staff reflect on the huge changes they have made. They are pleased to have moved on from hospital and have been engaging appropriately with their new placement.
*Name and image has been changed to protect identity
