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Mabel’s Journey – A Case Study

Mabel’s history

Mabel* came to Cygnet Alders Clinic in June 2016 with a diagnosis of borderline personality disorder. Mabel spent extensive periods of her childhood in care and had a history of trauma, neglect and sexual abuse. She struggled with alcohol and substance dependence, and engaged in significant self-harm and suicidal behaviours.

Mabel also had a history of violence and aggression to others, including threatening her family with a knife and assaulting staff. Mabel was first detained under Section 3 of the Mental Health Act in 1999; between 1999 and 2016 she spent less than a week as an informal patient. Mabel had been an inpatient at over 14 different hospitals, including high, medium and low secure services. She spent a short period of time being treated in the community on a CTO in 210, however her behaviours escalated and she was returned to a more secure unit.

Mabel also engaged in behaviours that would lead to her being treated at general hospital in order to gain access to opiates and other pain relief medication. This would lead to an escalation in her behaviour and she would become very violent and aggressive, often resulting in involvement with police.

When Mabel came to us

Prior to Mabel’s admission to Cygnet Alders Clinic, she was an inpatient at a low secure service. She was struggling with aggression, significant self-harm, as well as suicidal and self-destructive behaviours. Mabel was transferred to us for specialist rehabilitation specific to personality disorder, due to her high risk and attempts to end her life.

“It has changed my life.”

Mabel’s Care

At Cygnet Alders Clinic, we use a psychology based model and therapeutic environment to provide a constructive atmosphere to help individuals manage emotional instability and build positive relationships.

On admission, Mabel continued to engage in a high number of self-harming and suicidal behaviours, with 47 incidents of self-harm in the first 6 weeks of her placement. Mabel was involved in developing a risk management plan for her self-harming behaviours, which helped to reduce the frequency and severity of incidents. A multi-agency meeting between the local hospitals and Cygnet Alders Clinic was held to develop a comprehensive care plan to help reduce the incidents of her attendance at A&E.

At Cygnet Alders Clinic we adopt a positive risk taking approach. Mabel began to increase her Section 17 leave, work towards self-medication and decrease her observation levels in line with her risks. She began to increase her engagement in community activities and was supported by our occupational therapy department to develop a planned and meaningful structure to her weeks. Mabel particularly enjoyed Zumba, eventually progressing to attending classes independently and even being supported by the team to raise money for charity by taking part in a ‘Zumbathon’!

Mabel engaged with the Don’t Let Your Emotions Run Your Life group, in which she took a positive leading role, drawing on her significant previous experience of Dialectical Behaviour Therapy (DBT) and sharing her knowledge and skills with other service users.

In April 2017, following a number of positive Patient Review Meetings and prior to her CPA, Mabel didn’t return from unescorted Section 17 leave. She had become intoxicated and was threatening to jump from a local bridge. She was safely returned to Cygnet Alders Clinic and supported by staff following the incident. It became apparent that the idea of discharge was a significant trigger for Mabel, following so many years as an inpatient and having never lived independently in the community. It was therefore identified that her discharge planning would need to be graded and gradual.

Our psychology team supported Mabel in creating a Wellness Recovery and Action Plan (WRAP), reviewing her coping strategies and starting to think about her discharge plans. Mabel continued to express significant anxiety about discharge; however, she engaged well in this work and was able to start identifying her own needs and goals.

She was supported by the occupational therapy team to identify meaningful activities to provide her with structure in her placement upon discharge, such as local volunteering opportunities with animals and Zumba classes.

“After 18 years of being in hospital I finally have a future!”

Today

Mabel became an informal patient at Cygnet Alders Clinic in October 2017. She continued to be supported by the MDT to increase her independence and sense of control and responsibility. Her WRAP was reviewed regularly with her community team to ensure a comprehensive plan was in place for her return to the community.

With the support of the MDT at Cygnet Alders Clinic and the Community Mental Health Team, Mabel created a graded discharge plan over 6 weeks, increasing time spent at her new supported living placement, to build familiarity so she felt fully supported and integrated on discharge.

Following 6 months as an informal patient, Mabel had a positive discharge from Cygnet Alders Clinic in March 2018.

*Name has been changed to protect their identity

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