Mehmet was referred to St Peter’s Hospital following his initial recovery from a head injury, which had left him with frontal lobe damage.

Mehmet is a Turkish and Bulgarian national in his early 50s. Prior to his injury Mehmet had been a chef in many parts of the world, and was fluent in 5 languages. It is unclear how Mehmet sustained his head injury. He was found unconscious in a city centre where he may have fallen and hit his head, or it is possible that he had suffered from an assault.

Mehmet presented with extreme challenging behaviours which included serious assaults on staff, destruction of the environment, verbal abuse, shouting, and screaming.

A four-bedded NHS neurosurgical ward, where he was being treated previously, closed to admissions as other patients could not be placed within physical proximity of Mehmet.

During assessment the team learnt that Mehmet spent most of his time on the floor surrounded by mattresses, and he would only move around on his knees. Mehmet was able to sit in a chair, but would limit this to short periods of time due to discomfort.

Mehmet repeatedly shared he was experiencing stomach pains and constipation, but investigations could not identify any physical causes. Mehmet engaged in very limited activities, and spent his time either sleeping or in a highly aroused state.

What did Mehmet and his commissioners want to achieve?

• Review his medication plan
• Reduce his challenging behaviours, particularly those connected to risks with others
• Address his health issues
• Improve his mobility
• Encourage him to use a bed
• Engage him in more meaningful activities to improve his wellbeing and quality of life

What did we do to achieve these goals?

Mehmet’s new psychiatrist at St Peter’s focused on supporting his acute symptoms. A medication review resulted in a reduction in anti-psychotic medication and the introduction of an antidepressant

A Positive Behavioural Support plan was developed to help with his behaviours which included head banging, assaulting staff, verbal aggression, and throwing objects.

When Mehmet was first admitted he had pressure sores on his knees which have since healed, and he has been provided with specialist trousers with built-in pads to stop them from reoccurring. By engaging with Physiotherapy, he is now able to stand with a rail and walk short steps.

Staff have also worked with Mehmet to encourage him to stop sleeping on the floor and move to a profiling bed. This has provided him with a better quality of sleep, comfort, and dignity.

Mehmet’s stomach pain and constipation were thoroughly investigated and no causes were found. It is believed that these may have been stress related. As a result, opiate based analgesia was able to be discontinued.

Mehmet’s ethnic and cultural needs have been met by providing him with Turkish food, films, and newspapers. He is also served his preferred Halal food, which he was not receiving before.

He has also been provided with the Quran, and prescription glasses so that he is able to read independently.

An interpreter has been made available for his neuropsychology assessments, ensuring accurate quantification of his cognitive deficits and rehabilitation needs.

Recognising his previous work as a chef, Mehmet was encouraged by the Occupational Therapy team to engage in cooking sessions. This has proved to be a particularly positive experience for him; his aggression disappears, and he enjoys engaging with staff and showing off his skills.

Mehmet also enjoys pet therapy and community leave, which has been made easier for him through the acquisition of a specialist wheelchair

What were the outcomes for Mehmet?

Rationalisation of Mehmet’s medication resulted in a reduction in sedation which has improved his health and wellbeing.

Mehmet’s head banging has stopped completely, and his challenging behaviours have dramatically reduced.

There has been a considerable improvement in his mood, with a reduction in depressive symptoms and suicidal ideation and behaviours.

Providing food and activities appropriate to his cultural and dietary needs has also improved his mood and levels of social engagement. Contact with his family has been maintained through regular emails and telephone calls, and his family has flown over to the UK from Turkey to visit him.

Prior to arriving at St Peter’s Mehmet had not left a hospital setting for 18 months, but he now he enjoys regular activities within the community.