Luke

Luke is a 28-year-old, single man who was transferred to Kemple View from his local NHS acute psychiatric unit. He had recently sustained serious injuries in an accident while acutely psychotic and had a history of serious assaults, sexually disinhibited behaviour and absconding.

He had been diagnosed with schizophrenia, complicated by substance misuse. Attempts by an Assertive Outreach Team to maintain his wellbeing had been unsuccessful due to disengagement, non-adherence to medication and substance misuse, leading to repeated admissions.

Our first priority was to alleviate his psychosis in a safe, secure, therapeutic environment: he was admitted to Deneholme, our assessment ward.

He was initially treated with an oral atypical antipsychotic, but following education and discussion of the different options, made an informed choice to have a depot injection.

Luke’s psychotic symptoms gradually remitted and the team worked to develop therapeutic alliances with him.

He engaged in OT and psychology assessments, and gradually progressed to participation in a full weekly programme of therapeutic activities.

Meanwhile he completed group therapy to develop mental health awareness and address his substance misuse. Subsequently he demonstrated increased insight, motivation and strategies to avoid drugs in future.

We carried out a comprehensive review of his records and collaborated with him to produce a structured violence risk assessment (HCR-20).

When his mental illness symptoms had completely resolved, our psychologist administered the IPDE (a structured personality assessment using information from records and informants - self-report assessments of personality can be unreliable in offender populations). This yielded a diagnosis of dissocial personality disorder with narcissistic traits, in addition to his schizophrenia.

These assessments led to a formulation of Luke’s risks and informed an individually tailored programme of psychological interventions.

Following discussion with his NHS commissioner he transferred to Wainwright, our specialised low secure unit for men with personality disorder (with or without co-morbid mental illness). He saw this as a positive step towards discharge.

Luke benefited from a consistent, therapeutic staff approach, based on principles of positive psychology, underpinned by RAID ®. (The RAID ® approach is used on all wards at Kemple View.)

He successfully completed selected modules of the Life Minus Violence-PiC ® programme, gaining significant increases in insight and self-management skills.

In parallel with the above, Luke successfully engaged in a graded programme of community leave, progressing to unescorted leave which he used constructively to gain vocational qualifications at a local college; to test his self-management strategies and to practice structuring his time.

From the time of Luke’s admission and throughout his recovery we maintained regular contact with his family; local clinicians and commissioners, to prepare for discharge.

Two years after coming to Kemple View, Luke went to live in a part-staffed community placement in his home town, on a Community Treatment Order, and started a college course. His mother thanked the team “for giving me my son back”.