A 42 year old Male patient was admitted with severe anoxic brain injury, Pre morbid personality disorder, as a result of suicide attempt.

He has continued to be offered regular timetabled psychology sessions focusing on cognitive rehabilitation and appropriate stimulation. He has also been encouraged to attend psychology led group sessions focusing on well-being and cognitive skills and strategies.

He has engaged in OTA group sessions, completing ongoing formulation and assessment of need and the STARS recovery tool, but his engagement in 1:1 sessions has been more sporadic; he appears to benefit from the social aspects of a group. i.e. the weekly well man clinic, pop up pub and community engagement/home leave. He enjoys cognitive based games e.g., playing Connect 4 and Connect 4 using bouncing balls where additional motor and co-ordination skills are required. He also enjoys guessing the Catchphrase from picture cards.

In comparison to the withdrawal seen as a result of the necessary shielding, He has slowly but gradually appeared brighter in mood and more willing to engage since the end of the shielding and the ceasing of the quetiapine. He has attended psychology sessions in the afternoon but has declined sessions in the morning due to tiredness and problems with initiation.

 The patient appeared initially to be much disorientated to the layout of the service, and this seems to of affected his continence, therefore, orientation programmes were re-established, and he was supported with these on a daily basis. The deterioration evident that if he is not supported to follow the same routine and structure on a daily basis, then he quickly forgets and there is poor carry over. Despite having cognitive aids available to support his orientation e.g., orientation clock, He does not use these independently to support himself and needs prompting and support to use these.

The Multi-Disciplinary Team has been working with Speech and Language Therapy to use the Talking Mats to discuss topics, and this technique worked well. It is planned to use this to talk about his mood and well-being. To support his well-being, He has enjoyed listening to music and singing along at times and watching videos of tree surgery on YouTube to which he has offered spontaneous vocalisations.

Since his initial 8 week review, incidents of stressed and distressed behaviours have reduced and after 4 months he has transferred to our more independent recovery unit as part of his ongoing discharge pathway

He is looking forward in one day returning home to his family.

This case pertains to a male in his late 50’s, father of one, with strong family relationships. He had made a living as a craftsman and also engaged in various crafting pursuits in his spare time. He had an underlying heart condition, which at the time of his collapse was undiagnosed.

This male collapsed suddenly when out biking with friends. As a result he received a hypoxic brain injury which globally affected his brain function. He was unable to care for himself appropriately and required full time care and rehabilitation in a secure environment. A less restrictive environment was not suitable due to the male’s lack of insight into his injury and care and support needs. The patient lacked orientation to time and place and would often deem himself to be in his workshop. Due to lack of insight this patient often refused medications required to manage his mental health symptoms, he often invaded peers space and periods of agitation were frequent. Acceptance of assistance with personal care was also an initial barrier on admission.

The multi-disciplinary approach care and treatment plan focussed on restoring and maintaining cognitive function in order to promote optimum achievable independence. Treatment plans also focussed reducing behaviours that challenged patient and the other and on the importance of family relationships and meaningful occupation. The foremost focus for the entire staff team was to achieve a step down to a less restrictive setting.

Patient and the OT staff facilitated visits to his mother’s house to visit with family and talk about memories over a cup of tea. This was a very meaningful occupation for this patient and he voiced this regularly.

OT staff also accessed a local charity to restore this patient’s role in facilitating a woodwork group within the hospital.

Staff have established and maintained a regular daily routine in order to offer reassurance in familiar routines and engagement in personal care.

At the time of this report this patient is supported to manage his mental health behaviour therapy, psychology and IT intervention around his upcoming surgery to rectify his heart condition.

His risk behaviours have reduced significantly. He has regular contact with his family and friends. He is able to access unescorted leave with his partner. He is due to be transferred to a less restrictive setting once he has been supported through surgery and post recovery (behaviours and triggers) Patient period of stay has been

Patient agrees he is in a much better place now and is ready for his discharge pathway to continue after 16month placement at Windermere House.

Frank joined us at Jasmine Court in the summer of 2021. On admission he was suspicious of all food and drink and would only drink cans of fizzy pop. With the input of the staff teams specialist skills Frank no longer has these beliefs and is happy to choose a wide range of foods from our menu, he also enjoys supported visits to purchase items from the shops in the local community.

Franks family are really pleased with the care and support that they and Frank have received and the progress that has been made, as discharge planning progresses and plans are commenced to move Frank to a less restrictive placement they have said that they would rather he could remain at Jasmine Court.

Martin has been a patient at Jasmine Court Independent Hospital since early 2021. When he was first admitted Martin would isolate himself in his room for long periods and was reluctant to engage in therapeutic activities and treatment.

With the input of the staff teams specialist skills and a person centred approach Martin has built his confidence and Martin is now happy and keen to participate in many of the activities within the hospital, music and pet therapy, arts and crafts, gardening and playing snooker and pool in the local community.

Due to the progress that Martin has made he is now ready to begin the process of transition to a less restrictive placement closer to his family network. Martin’s family are really pleased with his progress and report that Jasmine Court is the best placement that he has had. Martin’s family praised Jasmine Court staff for their work with Martin and were very pleased with how relaxed Martin has become.

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. 

A female patient was admitted to us from a PICU who had a diagnosis of Korsakoff’s from heavy drinking over a prolonged number of years.  This lady was highly intelligent previously holding down a number of high profile jobs.  Things took a turn when she split from her husband and she ended up in a PICU.  She came to Forest hospital on high observation levels with a number of staff and was extremely aggressive, angry and confrontational wanting to go home.  At times this lady struggled to remember why she was in hospital and the support she required. 

When the lady was first admitted she was violent, angry and thought ‘the world was against me’.  Staff took time to get to know the lady, they supported her when she was angry and eventually she started to gain a therapeutic relationship with the staff and ‘felt safe’.  She would talk about her anger at home and how it made herself and her children feel.  She acknowledged she needed support and started working with the staff.  The ladies medication was changed and she started to feel well, she started running again with staff support, going out for meals and doing what she called ‘normal activities’ that had been taken away from her in a PICU which made her angry.  She described to the staff that she felt like a caged animal and didn’t think she would ever get any freedom again.

After a year or so she started a new relationship with her family, which took time and lots of support from staff to both the patient and the family and this was positive.  The MDT then had to look at a transfer to a new unit.  When this was discussed with the patient she was devastated as she was worried that she would end up going backwards.  We tried one service which only lasted a number of hours before she was aggressive and had to come back for more support and guidance. 

The staff then worked hard finding a suitable placement again and we had a 3 month transition plan. Both the MDT and the patient talked in depth about what the right support was needed and how we could ensure it was robust enough and that there were contingency plans in place. Staff would go with the patient for day trips to the service, they would stay overnight in the new service and would willingly do whatever was required to ensure the patient gained a therapeutic relationship with a new team. 

The lady is now in a community placement and is flourishing.  She continues to speak to the staff periodically to tell them how well she is doing and both the patient and her family are amazed at how far she has progressed and were very tearful with the staff and the MDT and could not thank them enough for all the care and support that has been given to the lady to ensure the second placement worked.

Mum and Dad stated ‘I cannot thank Forest Hospital enough it feels like for the first time in years we have our daughter back’.

The patient stated ‘I loved Forest Hospital the way they supported me through good times and bad times and regardless at what I threw at them they still came back and cared for me.  I didn’t think I would ever feel this well again, I cannot thank you enough’.