Meet John
As a young boy, John’s home environment exposed him to multiple adverse childhood experiences, loss and separation. His parents’ relationship was described as ‘volatile’ and ended with John’s mother leaving the family home together with his siblings. John was left alone with his father.
At 14, John ran away, leaving his home and father. He spent several chaotic years living on the streets or staying with people that he had met in those early years. During this time, it is reported that he experienced further trauma including physical, sexual and financial abuse. In his late teens, vulnerability, stress and trauma responses combined, and resulted in John becoming unwell. He was admitted to an acute unit and whilst on the ward he was assessed and given a diagnosis of treatment resistant schizophrenia. Due to his symptoms, John was admitted to a secure unit where he remained for over 10 years.
As a result of his experiences, and responses, John’s physical health has been affected. John has a diagnosis of Chronic Obstructive Pulmonary Disease (COPD), susceptible to chest infections, and has related heart failure complications. His symptomology, both positive and negative, and his understanding, can affect aspects of his daily living. John is not always aware of signs he is becoming poorly and those negative responses have an impact on mood, self-care and the ability to act. Understandably, physical health conditions have a direct correlation to mental health outcomes and so, when poorly, this can exacerbate associated symptoms of his diagnosis. John requires medications to optimise his physical and mental health, and these require careful monitoring.
This is the package of support we designed for John…
Accommodation
We worked with John’s referring team to find a two-bedroom flat for John in his hometown with easy access to the local amenities. To monitor John’s physical health, we equipped his home with a pulse oximeter, blood pressure monitoring machine and a thermometer.
Staff Team
We recruited a new staff team to support John in his own home. Each new team member had prior experience of working with people with mental health conditions.
Training
Each member of John’s new team attended our week-long induction and received training on trauma-informed principles, PROACT-SCIPr-UK® and first aid. In addition to this training, his team received specific training on treatment resistant schizophrenia and COPD. The team also received training on diagnostic overshadowing so they could recognise that a decline in John’s mental health could be linked to his physical health. Like all our teams, John’s team are trained to use NEWS2 (National Early Warning Score) to monitor physical health at home. NEWS2 is a tool developed by the Royal College of Physicians that improves the detection and response to clinical deterioration in adult patients. Due to his physical health, John’s team record a NEWS2 score for John on a daily basis.
Shared Interests
John has many interests, so we were able to recruit a team that shared his love of music, films, and visiting cafes and the seaside.
Clinical Input
Because of his diagnosis of COPD, we included some nursing hours into John’s package of support. Our nursing team offer advice on topics such as smoking cessation, good diet choices and the importance of exercise. His nursing team have organised regular appointments with his local COPD nurse and have made sure that he is under the supervision of his local heart failure team. Our nursing team have trained his support team on the use of NEWS2 to monitor any changes in John’s physical health and deliver further training when there is a change to John’s prescribed medication. As John has limited capacity, his staff team support him to use his inhaler and listen out for minor changes in his breathing. Staff monitor John’s physical health using NEWS2 daily as per his physical health plan and he must be booked into a GP surgery as an emergency if there is a decline in his mental health as this can be directly related to his physical health.
How is John today?
John still receives support from his team on a 1:1 24/7 basis. However, we reduced his package of support from a waking night to a sleeping night within his first two years with us.
We began supporting John in 2017. John is out in his local community most days. He enjoys going to his local café, to the seaside and keeping his flat nice and tidy. He is now very sociable, and he likes to take an active role in day-to-day routine tasks such as food shopping.
John does have significant physical health challenges. Using NEWS2 his team track his physical health on a once daily basis and more regularly if required. We can see from the diagram that staff take the appropriate action when NEWS2 scores are above 4. Prompt action is required to reduce time spent in hospital.
‘We all really enjoy spending time with John – he is always bubbly and happy to see us. He has the most infectious laugh and a fantastic sense of humour. He is also extremely caring and always asks us how we are!’
(Support Worker, John’s Team)