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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 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. Robert 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.

Lenght of Stay: 26 Months