John was 19 when he sustained a severe traumatic brain injury in a road traffic accident in 1994. He was admitted to the Brain Injury Rehabilitation Trust (BIRT) service in Glasgow, Graham Anderson House, in the summer of 2014 after it became apparent that John’s community care package was failing, putting him at significant risk.

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On admission to Graham Anderson House, the service’s multidisciplinary team assessed John over a month. John had cognitive difficulties, such as attention, concentration and memory. He processed verbal information slowly and would misinterpret people’s facial expressions leading to misunderstandings in social situations. He would often communicate his frustrations through verbal and physical aggression. Additionally, John had some issues with his eyesight and hearing.

To help John think of the long-term, he was asked about his goals, which included finding a meaningful activity to engage in and to make his family proud of him.

After the initial assessment, John’s rehabilitation began with a multidisciplinary approach addressing his cognitive, behavioural and social difficulties. John used an iPad for daily visual and verbal reminders to ‘take control’, such as a photo of the Fonz – an inspiration of ‘cool and calm’, as well as remind himself of his positive qualities and how he wants to represent himself to others. In speech and language therapy, John has been guided on misinterpreted communication and he has worked with staff to recognise words to avoid. In weekly sessions with the service’s Clinical Psychologist, they reviewed and reflected on his behaviours that week with use of a behavioural reward chart to help John recognise when he was doing well. John has also helped to develop an anger management guide for other service users in which he has reflected on his own experiences. John explains in his guide: "Although controlling my anger has been my main goal in rehabilitation, it is not the only part of who I am. I am thoughtful, funny, kind and quite talented when it comes to my artwork. There have been times when my anger has made me question my positive qualities."

Additionally, John explored use of hearing aids to manage loud and sudden sounds and has received regular visual scanning sessions.

John has developed an interest in creative outlets so has been supported to attend one to one art therapy and music therapy sessions, which have helped with self-expression and communication. John also now attends a weekly art group in the community.

Since starting rehabilitation at Graham Anderson House, John has improved insight into his difficulties and has developed an understanding of how these had become barriers to him progressing with a fuller life. The frequency and severity of his verbal and physical aggression has decreased, and he has learnt to walk away if he starts to feel angry. John’s mood has leveled allowing him to develop better relationships with the people around him, as well as to move from the initial five bed unit into the bigger main unit. Pamela Brown, Senior Clinical Psychologist and John's Clinical Lead, said:

John’s progress during his time in rehabilitation has been profound. We see a caring, humorous man who is insightful regarding his previous difficulties, and who wants to help others overcome challenges experienced following their brain injury. The team and his family are delighted with his achievements, and excited with his imminent move to a community house.

John’s progression means that he is no longer detained under the Mental Health Act and is now ready to be discharged from Graham Anderson House. He is preparing to move into a new BIRT community house where he will be able to live more independently.