Forest Hospital Case Study 2

A patient was admitted with complex behaviours and a type of dementia.  The patient was in an acute service but three days prior to being admitted was moved to a 136 suite due to his increased risk of violence towards others.  We agreed to admit the patient knowing that the risk of violence had increased and when we went to see him we could see he needed a lot of nurturing and support. 

On the day of admission, the patient was struggling with the size of the ward and how much space he had available.  Staff supported him and he did calm and work with the staff.  This patient also had a huge absconding history which we were also aware of.  The patient would remove windows from his room to be able to abscond and he had a working background of being a foreman, so we spoke to the patient and he started working with the maintenance man observing him and doing little tasks that he thoroughly enjoyed and this helped in gaining a good therapeutic relationship with the staff.

One of the barriers this patient had in the past was his absconding history and not going out on leave as previous placements were concerned about him not staying with the staff.  We decided as an MDT and with the patient/family that we would take some positive risk taking and start going out on leave.  The patient was nervous about this and staff agreed to support him with two staff and all his leave was planned.  There were a couple of times when he felt overwhelmed but the staff calmed him down and supported him to a less busy environment and he started to really enjoy his leave.  He would chat more to staff and after 6 or so leaves agreed that 1 staff would be suitable.  The attempted absconding stopped as he felt there wasn’t a need to do this behaviour anymore as he could go out when he wanted planned with staff.  After the positive risk taking he then worked with staff and we could evidence to the next placement that his risk was removed if he could have escorted leave or support in the community.

After 2 years of being with Forest Hospital we managed with his ICB to have a bungalow financed with wrap around care and with a good transition plan he successfully moved into the community where he still is now. 

The patient spoke about his struggles in previous placements and how he felt really restricted on the wards and the need to work against staff and to abscond.  He said that Forest supported him to ‘have a life’ and a ‘good quality of life’ and ‘staff have reminded me what life is like outside of services and I want to show my family I can achieve more than being a patient in a service’.  The staff thoroughly enjoyed working with this patient and how much was achieved in a short space of time.