‘He’s caused havoc everywhere he’s been. He’s rebelled against authority and displayed paranoia’
PATIENT X is a 40-year-old with schizophrenia and a long history of severe forensic violence.
He had a good upbringing but as a teenager began to have trouble relating with others at school, displaying violence and eventually being expelled and referred to child and adolescent services.
He got into a relationship and used illicit drugs, and has displayed numerous violent acts of assault and even attempted murder.
His mental health issues have never been properly addressed and he’s spent many months being moved around segregation units in prisons.
He has caused havoc everywhere he’s been. He has rebelled against authority, displayed paranoia and attacked staff.
He has been admitted to the State Hospital but he doesn’t think or understand that he is ill and requires treatment. A major aim for staff is to prevent violence and for him to interact with them.
Patient X remains confrontational and aggressive leading to periods of seclusion with supportive 24/7 observation. There’s ongoing engagement to maximise patient safety and initiate and build supportive therapeutic relationships. Several months into this and the patient remains verbally abusive but is accepting of medication and food.
Staff make it clear they will not give up on him. Detailed clinical observation and assessment is a key skill to determine his risks and needs: psychological, physical, functional, social and spiritual.
In time, he began to call staff by their name and became less hostile.
He is taken out of seclusion and into a ward setting, and eventually introduced to the group sessions in the hub involving the entire clinical team in the fields of nursing, occupational therapy, pharmacy, psychology, activity, recreation, social work and security.
The team is led by a consultant psychiatrist and Patient X is assigned a key worker, an experienced registered nurse responsible for day-to-day care planning and assessment.
Realistic medicine sessions involve other patients too and staff who volunteer from other support services to develop a total team approach to ideas for improvement, innovation and projects. In this case, a project was environmental – to work together to make the catering plastic-free.
Respect and shared enthusiasm progressed relationships and trust developed between the group, flowing into the entire care regime and relationships.
Conversations between staff and Patient X and other patients became more meaningful and respectful.
Staff make it clear they will not give up on him. Detailed clinical observation and assessment is a key skill to determine his risks and needs