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Ao and recovery

Multi disciplinary- includes OT, social work, nursing, medical Try to work out recovery style ways of working with the person One to feed back 3 ideas to the large group Be creative!
35 year old Asian male with paranoid schizophrenia, isolated, family problems, multiple formal / informal admissions, heavy In hospital, recovering. On Olanzapine 20mg. Referred to AO with recommendation from inpatient team for CTO. History of truancy, family breakdown, poor school performance, never held down a job more than 2 months. Was a good footballer in youth, involved in mosque in past but not in last year. Minimal contact with family. Previous interests include Persian poetry, Man Utd, into rap 35 year old Caucasian male with chronic bipolar disorder, poor housing, self neglect, recurrent admissions, history of deliberate self harm and chronic binge drinking. In community, on Lithium and risperidone oral. Reluctant to accept support and has disengaged from services leading to formal admissions 5 times in last 3 years. Divorced, small social network, mostly around pub. Lives in poorly Last worked as builder 8 years ago, poor work record after losing job with IBM as middle manager following manic episode. Affluent family, went to public school where experienced bullying, then 41 year old African Caribbean female with paranoid schizophrenia, continuously troubled by voices of ‘ghosts’, recurrent formal admissions, self neglect, very poor quality of life, history of violence (including assaults & threats with knife) related to paranoid beliefs about persecution by neighbours. On IM depixol 40mg. Previously in Medium Living in very poorly maintained flat, possibly being used as ‘crack den’. Concerns re exploitation. Has a boyfriend, also on AO caseload, brother heavy drug Difficult upbringing, mother SMI & in hospital repeatedly. Acheived good grades at school & started teacher training, Case Study 1: Imran
The goal of the care coordinator, ACT team and the inpatient unit is ideally to work with Imran to manage risk in the community, supported by brief informal admissions if concerned about mental health, rather than resorting to formal Assess strengths, consider longer term work interests. Look at accommodation, possibility of supported placement Initially daily visits to monitor mental health and early warning signs Involve in AO social/group activities (DJ sessions), close liaison with inpatient unit Start to discuss drug use and impact on life, use a MI approach to assess change - Assess family relationships, ideally joint visit to family home. Possible individual family work around abuse/ trauma & early losses Medication review: assess side effects, consider Clozapine, IM options, consider The goal of the team is to support Peter with maintaining his accommodation and helping him to feel more secure there, whilst acknowledging the ongoing concerns regarding his alcohol misuse Assess strengths, including interests in music/news, try to link with local social centre, possibly join a book group. Consider informal admission onto inpatient ward for alcohol detox Medication review: look at compliance, lithium wihdrawal AO visits twice a week (monitoring mental state, assistance with activities of daily living, social activities, monitoring alcohol intake) Support with attending gym / ongoing support with physical health Work to improve 50% compliance with medication Occupational Therapy assessment, look at return to work course Ongoing support for accommodation staff: agreed to cleaner twice a Encourage to attend Drugs and Alcohol Service weekly for Explore individual work around bullying at school, trauma in acute The goal of the team is to practically support Christine whilst Assess strengths, including fashion/ TV interests Contacted council and several respite admissions to supported Accommodation contract drawn up (no use of street drugs on premises / alcohol in room only). Some individuals banned MARMAP involved, police investigated & started prosecution, re Settled well in supported accommodation and offered further tenancy Team visited 3 times a week / medical review monthly, involved in Drug use reduced after move, work with dual diagnosis specialist Individual work around early life, family relationships Change to oral medication, under control of Christine: Quetiapine Start to explore possible voluntary work options, agreed long term

Source: http://www.psykiskhelsearbeid.no/multimedia/1849/Seminar-9-Rob-Macpherson2.pdf

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