Overview

When Jenny arrived at Oak Lodge, she had gone through several admissions to acute hospital settings over a period of 30 years and was detained under the Mental Health Act.

She was misusing alcohol and drugs and had chronic social problems, including social anxiety and difficulty understanding social norms. She would be verbally aggressive towards and regularly make false accusations of staff supporting her in the hospital.

While under section 17 of the mental health act (allowing unescorted leave), she would regularly leave the hospital and not return at agreed times to engage in drug and alcohol misuse.

Our approach

Positive risks

As Jenny would regularly leave the unit to use illicit substances and did not want to engage with an addiction support service, a meeting was held with her named nurse, care coordinator and consultant psychiatrist.

Jenny had expressed that she felt restricted by having to be at the unit at certain times, so it was decided to try the least restrictive approach of allowing her eight hours of unescorted leave from the hospital each day.

This new level of responsibility was an extremely positive intervention, motivating Jenny to achieve even more freedom through engaging in her recovery journey and working towards discharge.

Promoting independence

Jenny’s named nurse, senior practitioner, manager, support workers, and her care coordinator explained that any use of illicit substances would be a barrier to her moving on to more independent living, as her unescorted leave would be revoked by the consultant psychiatrist in the interest of her health and safety.

She took this seriously and abstained for a sustained period. Instead, she developed coping strategies by adhering to a structured routine with daily activities and chores, establishing healthy friendships and communicating openly with staff. This led to a period of stable mental health and improvements in her social skills and daily life skills.

She had cooking sessions with her occupational therapist twice a week and was offered to move from a single bedroom to a ‘bedsit’ style room within the hospital, which contains a kitchen and open plan living area, to assess her independent living skills. This was a great success, and she began cooking for herself every day and keeping it clean and tidy.

She then passed her assessment to move on to supported living with the supported living provider, which she had repeatedly failed to do previously due to guarded responses due to paranoia.

Outcomes

Free from substance abuse

Jenny no longer uses illicit substances, which had been contributing to her poor mental health and were a barrier to her living independently.

Moving to supported living

Jenny has now moved into a supported living service, with minimal support for medication management and abstaining from illicit substances.

Improved social skills

Jenny has moved from being acutely psychotic and uncomfortable in social situations, to socialising with others and openly talking about her long-term goals of owning her own flat and returning to college.

Testimonial

Jenny, in her own words, is “a new woman, and happy to start afresh.”