Tim was a 23 when he was admitted to Heatherwood Court. He had a complex history of trauma and abuse. As a child Tim had numerous admissions to CAMHS (child and adolescent mental health services) and later as an adult multiple admissions to acute mental health hospitals, both formally and under the Mental Health Act (MHA).
Tim had a long-standing history of hallucinations and delusions, and a diagnosis of schizophrenia had been established. He had a history of alcohol and substance abuse. He smoked around 20 cigarettes a day and his BMI was 40kg/m2.
Various community placements, including supported accommodation, inpatient unit, and psychiatric intensive care unit (PICU), had been unable to manage his risks, so he was admitted to Heatherwood Court, under Section 3 of the MHA to receive treatment in a secure hospital setting
Due to his chaotic behaviours, as a result of his psychosis, Tim had previously been prescribed a range of antipsychotic medications. Despite increased high dosages of the antipsychotics, Tim continued to report command hallucinations and delusions, and reported that the medications prescribed so far were of no real benefit.
Tim’s risks included verbal and physical aggression to staff and fellow peers, self-harming when stressed, environmental aggression and risks of absconding from hospital settings.
Tim was paranoid and showed no insight into his disorder. He also lacked confidence and believed he had no skills to show.
What did Tim and his Commissioners want to achieve?
- Provide a safe environment for Tim
- Manage his risk
- Encourage him to understand and self-manage his condition
- Review his antipsychotic medications
- Improve his physical health
- Develop the skills he would need to move successfully back into the community
What did we do to achieve these goals?
Following a thorough assessment by Heathwood’s Multidisciplinary Team his diagnosis was amended and treatment-resistant schizophrenia was established.
Following successful outcomes for other Heatherwood patients, treatment using low doses of clozapine was considered. A risk-benefit assessment was undertaken, involving Tim, the MDT and the pharmacist before the treatment commenced.
Careful monitoring of side-effects ensured that any adverse reactions were managed as the dosage was optimised.
In addition to the clozapine trial, the Occupational Therapy team also helped Tim identify what mattered most to him and create an interest checklist.
Building on this checklist, Tim was then encouraged to engage in a range of activities aimed at developing his self-confidence and gaining a more positive focus.
What were the outcomes for Tim?
Within 3 months Tim reported a significant reduction in his symptoms. He described auditory hallucinations as quiet whispers and felt more able to challenge them.
Tim started to show a real willingness to engage with his psychology sessions and was always eager to attend. He joined in all the other activities on offer at Heatherwood, including tie dying, paint pouring and soap making.
He interacted positively with both staff and other patients, and he started to develop close friendships. He was a regular in the gym, and in the games room he liked to challenge staff and other service users to frequent games of pool.
After an initial reluctance to engage in the kitchen and laundry skills sessions, he developed the confidence to make himself drinks and meals without any supervision and learnt how to use the laundry appliances to wash his own clothes.
In his community access sessions, Tim learnt how to use community transport and access local retail shops where he engaged in conversations with the shop staff.
After less than 10 months at Heatherwood Tim was able make the next step of his recovery pathway and transition on to a locked rehabilitation unit.
