Case Study: Leo’s Journey

Leo’s* history

Leo is a man in his late fifties, who has struggled throughout his life with depression, and aggression.

During his childhood Leo attended mainstream education, he struggled academically which led to him drinking, and engaging in self-harm.

Throughout these difficulties Leo also experienced several childhood traumas, he struggled to regulate his emotions after a sexual assault. This led to aggressive impulses resulting in criminal activities, such as arson attacks. He soon found himself in custody following a self-harm attempt after a night out which left him feeling upset.

Leo was admitted to a Psychiatric Hospital under Section 72 of the Mental Health Act. He had a period of unsuccessful leave attempts and upon his return to hospital, he decided to engage in therapy in order to be released.

When Leo came to us

Leo was accepted for transfer to Saunders Ward, our Low Secure service at Cygnet Hospital Stevenage, he struggled within this environment and after a spell of regular escalations and absconding he was stepped up the pathway and transferred to Peplau Ward, our Medium Secure service due to the need for a higher level of support and security.

Due to these risks, Leo was unable to utilise community leave during his first few months at Cygnet Hospital Stevenage. Leo struggled to engage with therapy, as he could not communicate his feelings. He was also having difficulties taking his medication, which led to an increase in his levels of anxiety and suicidal ideations.

Leo’s care

The Multi-Disciplinary Team (MDT) completed a full medication review with Leo, formulated a bespoke plan of therapy, and explained to Leo what he could gain from each session and team within the service. Soon after this review, he began to engage with many of the sessions. He attended cooking lessons, substance misuse groups, occupational therapy and psychology sessions, and continues to engage well with the community mental health team.

Working with the psychology team Leo has benefitted from specific therapies for fire setting, self-sabotaging behaviours, understanding of his mental disorder and personality functioning. He has admitted to communicating with unhealthy violent coping strategies, such as arson attacks, and has held conversations around the ‘ripple effect’ of his absconding, reflecting that his family, staff and himself were all affected by this. Leo has shown empathy and understanding of how others may feel. He has worked towards building a rapport over his past therapy and built a plan to reduce his risk of absconding.

Alongside the development of his communication skills, Leo has written letters to the psychologist highlighting his needs and hopes for the future. He regularly attends sessions with prepared topics to discuss. Leo has expressed a need to feel ‘in the know’ and likes to have open communication with staff to avoid assumptions which can lead to anxious thoughts and poor decision making.

Leo has also engaged with the occupational therapy team, where he has learned new computer skills. He has used these skills to apply for a voluntary job and to buy tickets to watch his favourite football team.

After engaging well with his therapy plan, Leo developed a deeper understanding of himself, his triggers and he had learnt healthy coping mechanisms. Leo was stepped down to Low Secure Services. The focus in his sessions turned to prevention, and for the first time in a long time he could see a future within the community.

Leo today

Whilst on the ward Leo regularly meets with the consultant forensic psychiatrist to discuss his future and transition process. This has had a positive impact on Leo and he has since established therapeutic leave to visit the community forensic team once a month within the community.

Leo is also taking regular escorted leave within the local community to visit his family and has started to rebuild key friendships.

He finds great enjoyment in volunteering at Cats Protection in the town centre. He also enjoys attending events put on by Cygnet, such as the Stevenage Carnival, as well as socialising and relaxing. As a lover of football Leo enjoys engaging with his fellow peers and staff whilst he watches the game in the lounge.

After being within inpatient and forensic services for over 30 years, he is now moving down the care pathway and is currently in a Low Secure Ward. Whilst Leo has had a few setbacks with his leave there are plans for his transfer to supported accommodation, with the support of the community mental health team. This is a huge achievement for Leo and he takes great pride in discussing his future plans with the hospital team.

Download Leo’s Journey
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*Name has been changed to protect his identity

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