Case Study: Developing a support package for a patient

(Joshua is a 32-year-old man of Jamaican descent. Although he has been living alone for the past two years, he has remained in contact with his widowed mother who is housebound due to mobility issues.)

Joshua had been in hospital detained under the Section 3 of the MHA (1983/2007) for four months following an acute episode of psychosis. This is his fifth episode and admission in the last ten years since his first episode at the age of 22. The community team looking after him have formed the view that he can no longer look after himself independently as his flat was infested with vermin and he had not been attending appointments for his depot medication. Joshua has been placed on the waiting list for a place in a long stay community rehabilitation home where he could be transferred under a CTO once a bed became available. However, this has been recently predicted to be at least a 12 months’ wait and the inpatient ward have asked Joshua’s community team to review the plan due to the pressure on inpatient beds. His Care Coordinator (Gary) has been on long-term sick leave for the past six months, so the Team Manager asked another member of the team (Mandy) to take over the role. She wondered how much Joshua had been involved in the existing plan of care and made an arrangement to meet him with her third year student (Eric) and explore his home situation again and begin to develop a share perspective of his recovery goals.

When Mandy and Eric got to the ward the next afternoon, the nurse in charge told them that Joshua was in bed in his room ‘as usual’, so they head off there and knock on the door. After a second time of knocking, Joshua calls out asking who it is; Mandy replies that she has come to talk with him about plans to help him get out of hospital. Joshua gets up and agrees to meet them in a quiet sitting room a few minutes later. Mandy introduces Eric as someone who can help Joshua work on his plans and starts by asking him what he would like to do after hospital. He tells them that he likes living on his own and wants to go back to his flat; that nobody will listen to him and that he is very fed up. He also tells them that he feels assaulted every time he is given his depot and that he stopped taking tablets before as the tablets kept getting stuck in his throat. Mandy and Eric offer to take Joshua back to his flat for a visit and to collect post and belongings a few days later as part of his S17 leave. When they get there it is clear that the flat is not infested with vermin, just untidy and sparsely furnished. Joshua is clearly very happy to be back there and tells them about some young children in the neighbourhood who had been tormenting him by putting dead mice through his letter box and shouting abuse at him. Between the three of them a plan is formulated for Eric and Joshua to spend a few visits tidying up the flat and then have some periods of leave there completing a strengths-based assessment to determine what kind of support he might need to go back and live in his own home again. Joshua left his flat with a broad grin on his face.

• What are the factors you think that helped Mandy and Eric to engage with Joshua?
• What are the likely reasons that this had not happened before?
• Who else could be involved in developing a support package for Joshua in the community?

Note: Reflect on how you might approach these situations. If you’re not sure, discuss with your tutor or placement mentor