Doug is a 50 year-old man with a diagnosis of Huntington’s Disease.

He has a significant forensic history that led to his detention under Section 37/41 of the Mental Health Act.

Doug presented with behaviours that challenge, and his mobility and swallow reflex had deteriorated significantly.

He was referred to St Peter’s Hospital for assessment, treatment, and rehabilitation as he required expert management of his mental and physical health needs, as well as the relational and procedural security that his forensic history and risk profile required.

What did Doug and his commissoners want to achieve?

• Reduce his challenging behaviours, violence and aggression
• Improve and stabilise his mental health
• Improve and maintain his mobility

What did we do to achieve these goals?

Doug’s acute symptoms were effectively managed with the introduction of psychotropic medication.

Initially he was apathetic and refused to engage with therapeutic activity, but by introducing a core staff team and a person-centred Positive Behaviour Support plan, it was possible to improve rapport and engage Doug in his care.

Doug’s mobility and swallow difficulties Doug were also regularly reviewed by the hospital’s inhouse Physiotherapists and Speech and Language therapists.

The team utilised HCR20 structured risk assessment, which provided a contextual understanding of Doug’s risk to others. Through MOJ liaison, Doug was also able to access the community via escorted Section 17 leave.

What were the outcomes for Doug?

He is now able to communicate more effectively with the use of written notes, and is actively involved in his own care and treatment planning. He has been provided with a modified diet which has enabled him to eat more, and in turn improved his nutrition and his overall health.

Doug requires support and long term management of his neurodegenerative condition and his forensic risks.

With it’s specialist multidisciplinary team and living environment, St Peter’s Hospital proved to be ideally placed to meet Doug’s complex and changing needs. Additionally, the hospital has been able to provide psychiatric assessment and liaison with the Ministry of Justice to ensure that his risks are appropriately managed.