Rami’s* history

Rami is a young man with diagnoses of schizophrenia, bipolar affective disorder (BPAD) and a mild learning disability. His first admission to mental health services was as a teenager, at which point he was diagnosed with BPAD. He went on to spend much of his adult life accessing support services and often experienced relapses requiring inpatient support. Rami was referred to Ramsey Unit at Cygnet Hospital Colchester when his placement was no longer able to support him.

When Rami came to us

In the weeks following his initial transfer to Ramsey Unit, Rami was very unsettled. He would often shout and display destructive behaviours when he was frustrated, which was worsened by his insomnia. He had threatened and assaulted other service users and staff members.

Although clearly very bright and self-aware, Rami lacked insight into his illness. Rami’s family, whilst keen to support him, would often exacerbate his paranoid feelings and beliefs due to a lack of understanding.

Rami’s care

Rami’s medications and discussed recommendations with both Rami and his family. They were initially unhappy with this and refused the changes. As he continued to be aggressive and became increasingly vulnerable due to aggression to his peers, the medication was changed and Rami began to accept that it was helping him to feel better.

The team used a multi-agency approach to formulate a plan to help Rami and his family to understand his condition, including local police, commissioners, community team and independent advocate.

Alongside Rami’s individualised therapy programme, weekly psychoeducation sessions were introduced where both Rami and his family could raise any concerns and the team could build stronger relationships as the trust increased. As Rami became more settled and his incidents reduced, his family could see that the team were acting in his best interests and were able to become a strong support system for him.

The team on Ramsey Unit had noticed patterns in Rami’s aggressive behaviours, recognising they often escalated from seemingly small events. They worked with him to support him to identify these triggers, suggesting coping mechanisms that he could draw upon before his feelings became overwhelming. Occupational therapy (OT) assessments indicated his levels of daily living skills were consistent with the diagnosis of mild learning disability, including needing support with grooming, food preparation, medication management, laundry, finances, shopping and transportation. Staff supported him to increase his skills in these areas.

With his mood settled and incidents reduced, Rami was able to participate in group therapy sessions and ward meetings. He was confident and vocal about his ideas and enjoyed having input into the decisions made about the service. He was voted the wards ‘Service user of the month’ on two occasions. The occupational therapy team were able to start taking him out into the community for walks, shopping and other activities.

Rami’s family were cautious at first about Rami having unescorted leave due to previous incidents. Therefore the MDT reassured them by using a staged, planned approach to build everyone’s confidence in taking these positive risks. Eventually Rami was able to spend time at home, where he and his family hoped he would be discharged to.

Rami today

The team worked with Rami, his family, the local commissioners and the community team to plan his discharge. A bespoke transition plan was formulated whereby a community support team was given training by the Ramsey Unit team until they were confident he was ready to live at home, and that they could support him effectively through barriers or difficulties that he may face.

After a successful period transitioning, Rami is now living at home with his family.

*Name has been changed to protect his identity