Case Study: Fred’s Journey

Fred’s* history

Fred is a man in his early thirties, who struggled throughout his life with drug and alcohol misuse. He attended a specialist school for individuals with challenging behaviours, after a violent incident in mainstream school. He was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and a personality disorder, but also experienced psychotic symptoms and emotional regulation difficulties.

Throughout these difficulties, Fred was never encouraged or supported to access any mental health services. He was referred for some sessions around drug use, which he attended, but his mental health needs were not addressed. Later in life, on the birth of his children, Fred spent a period of time drug free, but unfortunately relapsed and received a prison sentence following related offending. Whilst in prison, Fred experienced a lot of bullying and suffered from severe anxiety which led to self-harm. Fred was assessed and found suitable to transfer to Litchurch Ward, a low secure mental health service.

When Fred came to us

When Fred was admitted to the ward, he spent a lot of time in his bedroom. He was paranoid, delusional and disconnected from others. On occasions that he did enter communal areas, he would pace around and could become verbally aggressive to peers and staff, seemingly without provocation or warning. Fred was not willing to engage in any therapy.

When he arrived on the ward, Fred encouraged other service users to engage in risky behaviour, had refused medication and continued to try to access illicit drugs, either by making plans with visitors or by attempting to make arrangements whilst on escorted leave. The security breaches were on-going and Fred was at risk of moving to a higher level of security.

Fred’s care

The Multi-disciplinary team (MDT) explained to Fred that they couldn’t continue to safely support him on the ward. The open conversation seemed to be a turning point for him, and he suddenly understood the seriousness of the situation and the need to change in order to progress in his journey.

The MDT completed a full medication review with Fred, alongside the nursing and therapy departments. In addition to finding the right medication for him, they formulated a bespoke plan of therapy, explaining to Fred what he could gain from each session and team within the service. Soon after this review, Fred began to engage with many of the sessions offered to him. He attended substance misuse groups, psychology sessions, occupational therapy, and was engaging well with the service social worker.

There were times along the way that were challenging for Fred – when exploring his past in psychology and substance misuse sessions, it became clear to him just how much he had lost. Although difficult to face, this gave him motivation to work towards recovering some of these losses.

Fred visited his old home to clean out some possessions, and the memories of what life used to be like had a big impact. He was surprised to see how he had been living, and remembered how unwell he had become; but it also reminded him of the good times with his children, and furthered his motivation to take control of his life and future. The team supported Fred through these feelings, and encouraged Fred to think positively about his future.

The team on Litchurch Ward explored positive risk taking and building trust with Fred. He started to utilise unescorted leave to regain his independence, and was doing so without incidents.

After engaging well with treatment, Fred developed a deeper understanding of himself, his triggers and he had learnt healthy coping mechanisms. The focus in his sessions turned to relapse prevention, and for the first time in a long time he could see a future without illicit substances.

The team involved with Fred’s care agreed it was time to look at the next steps and that he was ready to move along his care pathway. They facilitated meetings with his community team, including a community psychologist, to provide wrap-around support in preparation for supported living a bridge to independent living.

Fred today

Following discharge, Fred continued to engage with the community team and regularly attended sessions with the psychologist that he was able to build trust with whilst at Cygnet Hospital Derby.

Today, he has returned to his home town and is living independently. Fred is achieving his goals in life, including remaining illicit drug free, and continues to access community support as needed. Most importantly for Fred, he has now regained contact with his children and is thrilled to be a part of their lives again.

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*Name has been changed to protect his identity

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