Josie is 49-years-old with Additional Learning Needs and mental health needs.

Josie grew up in her family home as the eldest of three sisters, all of which have additional learning and mental health needs. Josie’s childhood was described as “cramped conditions”, with reports of Josie receiving less attention than her siblings. Following her parents’ divorce when she was a teenager, Josie lived alternately between her mother and father’s separate homes.

From the age of 23, Josie was admitted to hospital numerous times as a result of a deterioration of her mental health, and aggressive and sexually inappropriate behaviours.

Josie also had a history of absconding and high-risk incidents, and she worried persistently about harming others and relapsing.

Her most recent acute deterioration was triggered by a series of significant events in Josie’s life, including the death of her father, the loss of her community nurse, and anxiety escalation during a holiday abroad with her co-tenants. During this time Josie also experienced a relationship breakdown with a new partner, and a subsequent incident resulting in police involvement.

Following this escalation, Josie was admitted to two separate assessment and treatment units before admission to Pinetree Court Hospital in 2020. When Josie arrived at the hospital, she presented with severe anxiety and intrusive thoughts, aggression towards others and her environment, and episodic self-harm.

She had a series of past episodes which included ligature attempts, and required high levels of staffing and close supervision at all times. Josie’s behaviours further deteriorated, and she was placed in a separate building as her behaviours were considered challenging. Restrictive interventions were also necessary at times.

What did Josie and her commissoners want to achieve?

The Pinetree Court Hospital team identified some goals for Josie’s placement in partnership with Josie, her family, and commissioners:

• Improve Josie’s quality of life
• Provide Josie with her own home environment
• Maintain positive relationships with her family
• Access the community and regain her independence
• Support her to develop emotional regulation skills

What did we do to achieve these goals?

To meet her individual environmental needs, a new bespoke studio flat was developed within the hospital grounds for Josie. The studio was specifically designed to minimise environmental and ligature risks and provide Josie with the least restrictive environment possible.

Following her transition to her new flat, Josie achieved a significant reduction in both the frequency and severity of incidents of distress and aggression.

Having her own living space provided Josie with opportunities to develop her independence and regulate her emotions in an environment that was safe, and enabled her to be alone when she required it.

Josie was provided with a consistent team of staff members who received specialist training to meet her individual needs, which had a positive impact on her feelings of safety within her new environment.

Josie also received treatment and support from the hospital’s wider multidisciplinary team, including input from psychologists and therapy professionals who were able to develop person-centred treatment, care, and positive behaviour support plans.

What were the outcomes for Josie?

With a bespoke person-centred environment designed around her needs, Josie no longer requires high staff dependency, and her aggression towards others and her environment has continued to reduce.

She has made vast improvements surrounding her quality of life and her emotional regulation, and throughout her time at Pinetree Court Hospital, Josie has developed consistent, positive, and therapeutic relationships with her staff.

Josie has regained her independence and has a much greater deal of autonomy in her daily life, and she feels more confident in both social and community settings.

She maintains a consistent routine of daily living and a structured activities programme that provides her with opportunities for socialising and community involvement.

She has achieved meaningful personal goals and overcome some of her longstanding anxieties, including visiting the cinema for the first time in years and accessing her local community via public transport.

Most importantly to Josie, she has been able to engage positively with her family, and enjoys monthly visits to her mother’s home and maintains strong relationships with her family members.