Carol is a 49-year-old lady who had a successful career as a Nurse.

She was diagnosed with Huntington’s disease and had been cared for in a specialist nursing home. Her needs could no longer be met as a result of increased agitation and aggression. Due to this deterioration, she was detained under the Mental Health Act.

On her admission to St Peter’s Hospital Carol presented as agitated and aggressive. There were multiple assaults on staff, and she was nursed on 2:1 levels of support to manage the risk she posed to others. Carol also refused to eat a healthy diet.

What did Carol and her commissioners want to achieve?

• A review of her medication
• Improve and stabilise her mental health
• Improve her physical health
• Understand the reasons for Carol’s challenging behaviour and reduce behavioural incidents
• Enable Carol to communicate effectively

What did we do to achieve these goals?

Carol was assessed by the multidisciplinary team at St Peter’s Hospital. Her Neuropsychiatrist carefully titrated her medication to help Carol alleviate her anxiety, and manage her impulsive and aggressive behaviours.

The psychology team also completed neuropsychological testing and a behavioural analysis, which led to the formulation of a person-centred Positive Behaviour Support Plan.

Carol also worked with the hospital’s Dietitian and Speech and Language Therapists to improve her dietary intake and communication.

What were the outcomes for Carol?

The multidisciplinary team worked effectively to improve Carol’s mental and physical health, and on our 16-week Assessment and Treatment Pathway she was able to be treated without the use of enhanced observations.

Carol remains at St Peter’s where she has now moved on to a Wellbeing Pathway, which engages her in meaningful activities focused on promoting independence, developing daily living skills, and helping Carol to manage her changing mobility and cognitive function.

Carol is now engaged with all aspects of her care and treatment. She has joined the interview panel at St Peter’s for new staff, and has been supported to interview candidates for the post of Psychologist. This has improved her self-esteem and confidence, and led to an overall improvement in her presentation.

The team at St Peter’s is now working closely with Carol’s commissioners and the community Huntington’s Disease Nurse Practitioner to find an appropriate placement for Carol to step down to.