Patient L is a 64-year-old lady with a diagnosis of Bipolar Disorder who had first been admitted to a local NHS psychiatric ward in January 2018, following a period of non-compliance with prescribed medication whilst living in the family home with her husband. There had been a failed attempt of discharge home (March 2018 then readmitted in May 2018) before a further period of time as an in-patient on the NHS psychiatric ward under Section 3 of the MHA.
Reports from the NHS ward staff indicated that Patient L presented in a verbally hostile and aggressive manner for extended periods of time, on a daily basis. The verbal hostility and aggression were directed towards hospital staff and also her husband. Reports at the time indicated that she was non-compliant with oral medication (mood stabiliser) but accepting of depot medication (anti-psychotic). Patient L was not accepting of her need for care and treatment and was often resistive to support when offered. Her risks were identified as being (a) risk to others; (b) risk of self-neglect when non-compliant with medication. Following a refusal to return from home leave (she had to be returned to hospital by the police), all Section 17 leave was stopped in December 2018.
Patient L was transferred from the NHS psychiatric ward to John Munroe Hospital in February 2019. Initially she presented in a similar manner as when she was on the NHS ward – shouting and verbally hostile towards others, on a daily basis, for extended periods of time, refusing oral medication and neglecting her self-care needs. She would also choose to spend much of her time in her bedroom area, only coming to communal spaces at mealtimes.
The nursing and therapy team along with her RC spent time building a therapeutic rapport with Patient L, as well as including involvement from her extended family (husband, children and grandchildren). The importance of medication compliance was reinforced and psychoeducation about her diagnosis was provided. Frequent discussions were held with Patient L (and her family) to highlight that her treatment at JMH was to enable a successful discharge back home. Compliance with oral medication was no longer an issue.
Psychological assessment and functional analysis of her presenting behaviours led to the development of a team formulation and positive behaviour support plan. The identification of factors which were precipitating and maintaining certain cognitive, emotional and behavioural patterns enabled a more meaningful and individualised approach to her care and treatment to be implemented.
After a relatively short period of time Patient L developed a level of trust with members of the MDT. Patient L stated that she felt that spending further periods of time in hospital was not helpful and that she wanted to spend time at home again. Periods of leave to local shops went successfully, so a plan was made for Section 17 leave to the family home. Patient L frequently stated that she felt ‘listened to’ by the clinical teams. The first period of leave to the family home was a success, with Patient L cooking and tidying, but also sitting and relaxing. There was no resistance to returning to the hospital, with the assurance from staff that anther visit home would be planned.
After a relatively short period of further escorted visits to the family home, Patient L spent time at the family home without staff. This then led to periods of time on overnight leave – building up from 1 or 2 nights to a full week and more. Throughout these periods of leave Patient L remained compliant with all medication – returning to the ward for her depot medication and contacting the ward to arrange for staff to drop further medication (weekly blister pack) to her home. She reported that she had ‘never felt so well’. Her husband too reported that he felt that his wife had not been this mentally well for several years. Patient L was successfully discharged home in August 2019.
She was admitted to NHS hospital in January 2018, transferred to John Munroe Hospital in February 2019 and six months later discharged to her family home. Patient L and her husband sent a Christmas card to the teams at John Munroe Hospital, to thank them for her care and treatment.