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Leanne – Treating Psychosis and Personality Disorders

04 Mar 2019 | BY John Munroe

Leanne was admitted to JMH and our Personality Disorder service from Sedgley House, Wolverhampton as an informal patient. She was awaiting a court hearing for assault with two outstanding suspended sentences already in place. She had a working diagnosis of substance and alcohol misuse, drug-induced psychosis, antisocial personality disorder, and borderline personality disorder, with a long history of aggressive behaviours.

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

Leanne had retained her everyday functional skills and as she had settled well she was transferred to the rehabilitation bungalow, High Ash. It was noted that when she was engaged in the activities of daily living she appeared more able and more willing to talk about where she believed her own problems existed and also consider ways of addressing these.

She was able to recognise that culture and circumstances had influenced her drug and alcohol misuse which in turn had led to assaultive and aggressive behaviours and that when the cycle was broken then changes would occur. Staff re-enforced her understanding on a regular basis and supported Leanne to both retain her understanding and make the necessary changes to her lifestyle and her perceptions of what is an acceptable way to behave in a social context.

Leanne was also supported when she attended her court case and she felt able to own her past behaviours, choosing to change her plea from not guilty to guilty. She was awarded three suspended sentences after JMH staff presented a report to the court stating that Leanne was engaging in therapy, looking at antecedents, and consequences of past behaviours. Subject to her continued engagement the judge awarded Leanne a third suspended sentence. As she was an informal patient, all elements of her input were addressed through negotiated contracts in which Leanne was an active participant and took a lead in her own care. She also 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 her own activities of daily living.

Leanne’s family were also involved and informed in her care pathway progress throughout, at her request.

After a 20 month stay in our mental rehabilitation hospital, the next stage in her therapy is taking part in voluntary work in the community and her discharge is planned within the next month to supported accommodation in the community.