Adam’s* history

With a diagnosis of Schizophrenia, Adam, who was in his early 60s, had a forensic history having spent over three decades detained in various hospitals including high secure. He had a prominent history of cannabis use, as well as gambling, both of which contributed to his risk of aggression.

Adam was very mistrustful and pessimistic about his future, believing that he would never be found suitable for community living. Thereby his ambivalence about stopping cannabis use.

When Adam came to us

Adam was transferred to us from a medium secure unit, detained under section 37/41, with no authorisation for section 17 unescorted leave. He would present with marked aggression and significant mistrust of his staff team. His medication was reviewed
and with input from Psychology and Occupational Therapy (OT), we were able to achieve unescorted leave for him from the Ministry of Justice (MoJ).

Adam would use cannabis and there was a repeated cycle of losing his leave and then regaining it. Subsequently he gave up on making efforts to engage in any activity as he believed no matter what, he was not going to be discharged.

Adam’s care

The multi-disciplinary team (MDT) worked on his insight, self-esteem, developing social skills and motivating him to abstain from cannabis use and gambling and rebuilding his life in the community. Prolonged psychological intervention resulted in Adam embracing a positive outlook and changing pessimistic views to optimism. He was constantly given positive feedback for the smallest of achievements thereby reinforcing in him his strengths and enthusiasm to return back to the community after a prolonged admission. More specifically a substance, misuse group, Life minus violence group, cooking sessions (decades ago he was a chef) and encouraging other service users in playing pool on the ward led to a reduction in aggression.

Adam became a role model and sat in interview panels recruiting staff. He got a paid job on the ward in which he facilitated the breakfast club for other service users. Additionally he assisted an OT in shopping and buying daily newspapers for the ward. This led to him having a sense of responsibility and enhanced his self-esteem which propelled him towards independent living. His unescorted leave was gradually increased, he remained abstinent from cannabis and engaged in meaningful activities like working in a charity shop. On our recommendation, the tribunal conditionally discharged him.

Adam today

Adam has now moved on from Cygnet Lodge Lewisham and is living in a low level supported accommodation in the community. The team feels very rewarded when Adam re-visits the unit to share his progress and gratitude. He is observed to be mentally stable, asymptomatic and abstinent from substances.

*Name has been changed to protect his identity