Male case study

David

At the age of six David sustained an accidental head injury which resulted in marked behavioural changes. At twenty five, after a serious road accident, a psychiatric report diagnosed severe pre-morbid personality disorder. David was subsequently detained for treatment under the Mental Health Act 1983.

David was admitted to Elm Park with short term memory problems, destructive and self-harming behaviours, verbal perseveration and expression of paranoid ideas and non-cooperation with medication and mobility problems. The specialist team prioritised his destructive and self-harming behaviours and a behaviour modification programme was initiated. To ensure he and others remained safe at the early stages of his programme, 'as required' medication was prescribed and psychological/physical intervention techniques used. As awareness of the positive effects of prescribed medication grew, he began to co-operate and took a daily oral medication.

As a result, David's self-harming and destructive behaviour decreased rapidly and his treatment plan was modified. Parallel to the behavioural modification programme, a mobility programme, including regular swimming and daily assisted physiotherapy sessions, was set up and David was able to walk and carry out tasks unaided. An individual care pathway was instigated to aid David's functional skills, memory and cognition. David responded to the new pathway engaging in this part of his rehabilitation programme. This interaction resulted in his behaviours becoming settled, allowing him to gain further independence.

With David's positive improvements in all areas, a graded discharge was granted (under section 17 of the Mental Health Act) to Community Rehabilitation and Supported Living (CRSL) in Essex. No repeats of his past destructive or self-harming behaviours were observed during his stay at CRSL and he was discharged from section 3 of The Mental Health Act. After just over three years from admission to Elm Park, he moved into his own bungalow. He now receives daily visits from a support worker and regular visits from a community mental health nurse to ensure that he continues to take his medication and is able to live as independently as possible.

Case studies in this brochure are based on real events, but names have been changed to protect the identity of the individuals involved.

Brain injury units

	Northamptonshire
	Brain Injury Services, Northants Tel: 01908 543 131
	Essex
	Brain Injury Services, Essex Tel: 01206 231055

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