Sally* has bipolar disorder and sustained a severe traumatic brain injury in 2012 following an attempt to take her own life.

Once she was medically stable, Sally was transferred to a nursing home where her behaviours deteriorated and resulted in a move back to general hospital where she was over-sedated and did not leave her bed for almost one year.

In May 2015, Sally was admitted to York House and required 5:1 support from staff for all personal care and feeding. Due to Sally’s cognitive and communication difficulties, her only way to communicate her anxiety was through physical aggression. This was difficult for the staff supporting her, so in line with the Brain Injury Rehabilitation Trust (BIRT)’s multidisciplinary approach, the Psychology team developed a compassion-focused routine to help staff understand how she was feeling. This enabled staff to concentrate on reducing the feeling of threat she experienced.

Care was also taken to make Sally feel safe and happy in her environment. Her room was personalised to feel homely and slow handovers between the 1:1 support teams were introduced to help avoid disorientation.

music therapy session at York House

The multidisciplinary approach was important in many aspects; Speech and Language Therapists worked with Sally to improve her communication and additionally supported her to begin to self-feed again. She has sessions with our Music Therapist because she loves music and singing. Physiotherapists and Occupational Therapists have worked jointly to support Sally in spending more time out of bed by increasing her mobility, and she is now practising walking with a frame. However, Sally was admitted highly sedated, meaning that she could not engage in rehabilitation. Psychiatry and Nursing worked closely to reduce the medications and her acceptance of them.

Sally is now able to get out into the community. This has been a gradual process, starting with short drives out in the minibus building up to the point where Sally now visits local attractions.

Throughout all the parts of Sally’s rehabilitation, communication between the team was essential. Tutorials and meetings were set up, allowing support staff to feedback how things were going, and for the Clinical Team to communicate care plans. Following any difficult situations, debriefs were held to allow staff to reflect on what happened and provide additional support.

Sally’s family are supportive of her and the team at York House. They are delighted with the progress she has made. Although they can’t visit often due to the distance, Skype is going to be set up to help maintain contact.

*Name has been changed

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