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Robert – Schizophrenia and Rehabilitation From Substance Misuse

04 Mar 2019 | BY John Munroe

Robert had been transferred from Stepping Hill hospital to JMH’s schizophrenia service in Leek, with a diagnosis of Dissocial Personality Disorder, a Schizoaffective Disorder, and a history of poly drug and alcohol misuse. He had a long history of assaultive 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 build a positive therapeutic working relationship with him and to support 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 and agreed to complete a range of functional assessments to provide a baseline of his current skill levels with the understanding that he would need to be sure he could look after himself after his eventual discharge.

Robert worked with staff in a specific person centred, graded, and adapted programme of therapeutic interventions and activity sessions that were negotiated to provide Robert with a structured and focused day. He 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, 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 of the therapeutic programme to increase his fitness levels he purchased a bicycle and either walked or cycled three miles to the local town every weekday. 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.

He 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 sessions, gambling and substance prevention, and alcohol awareness work with therapists using a CBT approach but graded to a level that made it easy for Robert to understand. Robert was also encouraged and supported to research these subjects for himself using the internet, which was a medium he was familiar with and had meaning to him. The work also included Robert 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 at 26 months in our mental health rehabilitation hospital and was discharged back to his home area into supported accommodation, which Robert was extremely pleased with as the next step towards full independence.

Lenght of Stay: 26 Months