Case Study: Tom’s Journey

Tom’s History

Tom* arrived on Meridian Unit in his sixties, having been diagnosed with paranoid schizophrenia in his early twenties. Since then, he had spent a total of over 13 years in hospital, struggling with hearing voices and impulses to damage property. Following a number of failed discharges, Tom was referred to Meridian Unit at Cygnet Hospital Blackheath for further assessment, treatment and rehabilitation.

When Tom came to us

On admission, Tom would often display verbal and physical aggression towards others. Initially, he would damage both his own property and that of other service users on the ward as a coping mechanism, including smashing windows and destroying furniture. At the beginning of his stay, Tom was reluctant to engage with support offered by psychology and occupational therapy teams, and they understood the need to work patiently with him, slowly gaining his trust.

Tom’s Care

Over time, the Multi-disciplinary team (MDT) built up a trusting rapport with Tom, and he gradually began to engage in both 1:1 and group sessions with the psychology and OT teams. The staff worked together with Tom to find new ways of managing his impulses to destroy property, including ripping up newspapers and magazines instead of more valuable objects, or the belongings of other service users.

Tom also received support to improve his self- care and attended ‘stress less’ sessions to help manage his anger. Over time, Tom became much less aggressive: his racial and verbal abuse slowly reduced and his behaviour towards others changed dramatically. By the end of his stay on Meridian Unit, Tom was pleasant towards others on the ward and would complement staff on the work they were doing.

Tom Today

Tom was discharged in January 2021 to an open rehabilitation service, where he is able to come and go as he pleases. After so long in hospital and prison, this is a huge achievement for him. His history of damage to property had made it particularly challenging to find a suitable community placement for him, but his continued hard work and the commitment of his community team paid off.

In light of previous failed discharges, those involved in Tom’s care recognised the importance of a well-managed, gradual transition back to the community. The Meridian Unit team worked with Tom, his community team and his new placement to ensure that his discharge was successful. They shared insights about working with Tom and some of the coping strategies that he had developed whilst on the ward.

Tom is now able to manage his impulses to destroy property; his interactions with others are much more pleasant and, despite his history, has been able to move successfully back into the community. The team are really proud of the progress Tom has made and wish him all the best at his new placement.

*Name has been changed to protect his identity

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