Recovery / Success Stories

Case Study 1 – Gorden

Gorden had been transferred to the John Munroe Hospital from an HDU NHS ward, where he had spent over 24 months on Section 3 with complex mental health problems and a difficult to manage physical condition.

 

During his time on the HDU Nursing staff report that although there has been little change in Gorden's mental health since his admission to the Windermere Ward, within the past 3 months he appears to have become slightly more responsive (in comparison to his flat presentation), occasionally presenting as elated; staff postulate that Respiridol (Oral) has had a positive effect which lead to the referral and ultimately to the admission to the JMH for intensive rehabilitation.

Gorden was at the JMH for just under 12 months. Gorden's program at that time involved CBT on a sessional basis which helped him develop coping mechanisms and the promotion of social inclusion by the nursing and occupational therapy team which helped to build up his self confidence in order to move forward.

During his rehabilitation programme Gorden worked on his budgeting skills, shopping, cleaning and cooking and also how to manage his complex physical condition effectively without impacting upon his mental health.

During his intensive rehabilitation programme he commended a successful self-medication programme which enabled the next step of the process – stepping down from hospital. Gorden was involved the process of finding suitable supported living accommodation back at his home town with support from the staff team and his family. This enabled the successful realisation of his end goal.

The feedback from the key stakeholders in his care was that they had never seen Gorden as well as he is was on discharge. All the JMH Staff wished Gorden all the success in the future and have no doubt he will be a success.

 

 

CASE STUDY 2 – Robert

Robert had been transferred from Stepping Hill hospital to JMH with a diagnosis of a dissocial personality disorder, a schizoaffective disorder and a history of poly drug and alcohol misuse.

Robert had a long history of assaultative and offending behaviours all closely related to his substances misuse. Robert himself acknowledged that these were his problems and his responses also were related to feeling threatened on a ward full of young adult males.

In a detailed interview, Robert identified that his longer term goal was to break the cycle of his substance and alcohol misuse and to move eventually to his own flat in the community.

The focus then of Robert's rehabilitation programme was for staff to built a positive therapeutic working relationship with Robert and to support Robert in his social integration into his new environment in order that he feel less threatened. Robert also agreed to work on his substance and alcohol misuse. He also agreed to complete a range of functional assessment to provide a baseline of his current skills levels with the understanding that he would need to be sure he could look after himself after his eventual discharge.

 

Robert worked with staff and a specific person centred graded and adapted programme of therapeutic interventions and activity sessions was negotiated to provide Robert with a structured and focussed day.

 

Robert responded well to this practical and easily understood programme recognising he was practicing new skills and maintaining his current skills which he would need to manage on his own in the community.

 

It also emerged at this time that Robert had problems budgeting his monies and that he had a gambling addiction which he acknowledged. A negotiated support plan was implemented.

 

Robert moved then from the adult mental illness unit to the rehabilitation bungalow [onsite at JMH] wherein his graded programme he took on more responsibility for his own self management whilst being supported and encouraged by his care team.

 

Robert achieved daily S17 leave and as part the therapeutic programme to increase his fitness levels he purchased a bicycle and either walked or cycled the three mile to the local town every week day. He also participated in the weekly walking group with fitness and exercise and social normalisation as well as promotion of appropriate leisure activity as the focus.

 

Robert had a full and structured week composing of practical functional skills interventions such as participating in cooking groups and community skills session as well as leisure based activities such as art and craft groups and nature groups where he could practice his social skills.

 

Robert also participated in 1:1 budgeting skills and gambling, substance and prevention work as well as alcohol awareness work with therapists using a CBT approach but graded to a level that made it easy for Robert to understand. Ryan was also encouraged and supported to research these subjects for himself using the internet [a medium he was familiar with and had meaning to him]. The work also included Robert also examining coping strategies and new ways of thinking around his addictive behaviours that made sense to him.

 

Robert was deemed by his care team to have achieved sufficient skills and demonstrated sufficient commitment to changing his lifestyle and was discharged back to his home area into supported accommodation which Robert was extremely pleased with as the next step towards full independence.

 

 

CASE STUDY 3– Lenny

Lenny was admitted to JMH from Sedgley House, Wolverhampton as an informal patient. He was awaiting a court hearing for assault with two outstanding suspended sentences already in place.

Lenny had a working diagnosis of substance and alcohol misuse drug-induced psychosis, antisocial personality disorder & borderline personality disorder and a long history of aggressive behaviours.

Lenny had been offered and taken part in specific psychological interventions to address this at Sedgeley House but had not responded well to this approach and had eventually declined attendance.

Lenny was admitted initially to Horton ward. In the first instance staff concentrated on developing a good therapeutic working relationship. This facilitated Lenny being able to discuss his past behaviours.

Lenny had retained his everyday functional skills and as he had settled well he was transferred to the rehabilitation bungalow – The Larches.

It was noted that when he was engaged in the activities of daily living he appeared more able and more willing to talk about where he believed his own problems existed and also consider ways of addressing these.

Lenny was able to recognise that cultural and circumstances had influenced his drug and alcohol misuse which in turn had led to assaultative and aggressive behaviours and that when this cycle was broken then changes would occur.

Staff re-enforced this understanding on a regular basis and supported Lenny to both retain this understanding and make the necessary changes to his lifestyle and his perceptions of what is an acceptable way to behave in a social context.

Lenny was also supported when he attended his court case and he felt able at this point to own his past behaviours choosing to change his plea from not guilty to guilty. He was awarded three suspended sentences after JMH staff presented a report to the court stating that Lee was engaging in therapy looking at antecedents and consequences of past behaviours. Subject to his continued engagement in the same the judge awarded Lenny a third suspended sentence.

As Lenny was an informal patient all elements of his input were addressed through negotiated contracts in which Lenny was an active participant and took a lead in his own care.

Lenny agreed to regular drug and alcohol screening after unescorted time spent in the community and agreed to continue with an organised weekly structured routine of completing his own activities of daily living.

Lenny's family were also involved and informed in Lenny's care pathway progress at his request throughout.

As a next stage in his therapy Lenny is currently now taking part in voluntary work in the community and his discharge is planned within the next month to supported accommodation in the community.