Patient case study – meet D

Aderyn is a specialist male rehabilitation service for men with a diagnosis of Mental Illness and/or Personality Disorder. The service also offers a two-bed step down cottage.

Carmel Gealy, BA (Hons), MSc, MSc, C.Psychol, AFBPsS Chartered Forensic Psychologist has completed the following case study on D.

D is a 49 year old man who was admitted to Aderyn after spending a significant amount of time on an acute ward. He has a diagnosis of schizophrenia and has had contact with mental health services since the age of 19, with numerous previous admissions.

He has a number of difficulties including poor ability to understand or predict what is to occur in his day to day routine, poor ability to handle frustration and control emotions, difficulty learning new information, repetitive speech, agitation and expression of suicidal thoughts.

He struggled to express himself, repeatedly stating that he wanted to kill himself, and at times, used behaviours that challenge such as shouting and using aggression as a means of communicating his needs.

D has complex needs and it has been important to individually tailor support and develop a range of person-centred approaches to his care. Within the first few weeks the Responsible Clinician reviewed D’s medication and optimised his treatment with prescribed medication. In addition, multi-disciplinary individualised care plans and a Positive Behaviour Support plan were developed to focus on improving the quality of D’s care, especially in areas known to be associated with behaviours that challenge. These included: predictable environment; opportunities for choice; positive social interactions; more independent functioning; and personalised routines and activities.

Over the course of a few weeks, D adjusted well to the calm and spacious ward environment at Aderyn. To reduce uncertainty, an individualised timetable was developed; D’s day is now a structured routine which helps prepare him for events and challenges that he may face and his agitation has improved greatly. He needs encouragement at times to engage in activities, but he particularly enjoys walking in the extensive grounds and going for drives in the surrounding countryside. The continuity of staff has been of benefit and D has built therapeutic relationships with a number of staff members; for whom he likes to make cups of coffee.

As can be seen on the chart below, there has been a significant reduction in the number of recorded incidents of behaviours that challenge, with none reported in the last two months.  D generally presents as more calm and less agitated.

D’s speech remains repetitive at times, however staff are aware that repeating his phrase back to D reduces the perseveration. It can be difficult to understand him at times due to rapidity of speech, however D is willing to be directed by staff to slow down; his speech becomes clearer and he is able to better communicate his needs resulting in less frustration and a reduction in the frequency of incidents occurring.

There has also been a change in attitude towards D from his peers. There was initially some hostility verbalised towards D due to his behaviour, however this has ceased and his peers are accepting of D (e.g. lighting his cigarettes).

In his previous placement D received visits from his parents 2-3 times a week; these generally caused D agitation and visits were often cut short due to risk of violence towards his parents. Parental contact continued to be an issue in the early stages of his admission to Aderyn. D was care planned to call his parents in the early evening. However this was problematic as he became agitated and made threats down the telephone. Due to D’s poor mental state and agitation (during the first few weeks of his admission), which appeared to be exacerbated by family contact, it was agreed that whilst D continued to settle at Aderyn, it would be in his best interests for family contact to be postponed for a short period.   Following an improvement in his mental state, D’s parents visited again. The visit went very well and lasted much longer than previously. D was calmer and hugged his parents. He has since asked to see his parents again and visits continue to go well.

D’s progress has been gradual but significant and led by multi-disciplinary team interventions. He has benefited from a consistent approach to his care, and has integrated well and developed positive relationships with staff.

If you would like to visit Aderyn or would like more information about the service, please contact Sarah Thomas, Partnership Development Manager.