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Case Study: Doug

Doug is a 50 year-old man with a diagnosis of Huntington’s Disease.

He has a significant forensic history that led to his detention under Section 37/41 of the Mental Health Act. Doug presents with behaviours that challenge and his mobility and swallow reflex have deteriorated significantly.

He was referred to St Peter’s Hospital as he required expert management of his mental and physical health needs, whilst being able to provide him with the relational and procedural security that his risk profile requires.

What did Doug and his commissioners want to achieve?

  • To reduce his challenging behaviours, specifically his violence and aggression
  • To improve and stabilise his mental health
  • To improve and maintain his mobility

What did we do to achieve these goals?

Doug’s mental health problems were effectively managed with the introduction of psychotropic medication. Initially he refused to engage with therapeutic activity, presenting with marked apathy, which is a feature of his Huntington’s presentation.

By introducing a core team, to implement Positive Behaviour Support plans it was possible to improve rapport with Doug.

To address his mobility and also his swallow. He is regularly reviewed by Physiotherapist and Speech and language therapists.

Doug remains impulsive and presents a risk to others. The team at St Peter’s utilise HCR20 structured risk assessment, and it has been possible to offer Doug regular Section 17 leave, with the consent of the Ministry of Justice.

What were the outcomes for Mr D?

He is now able to communicate more effectively with the use of written notes and is involved in his care and treatment planning.

He has been placed on a modified diet which has enabled him to eat more and in turn benefited his overall health.

Doug will require long term management of his neurodegenerative condition and the associated risks. With its specialist multidisciplinary team and living environment, St Peter’s is ideally placed to meet Doug’s complex, and changing needs. We are also able to provide psychiatric assessment and liaison with the Ministry of Justice to ensure that his risks are appropriately managed.

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