We are particularly proud of Oliver for how he has been able to engage in the psychology programme. He has developed a trusting relationship with his therapist and talks honestly about his feelings. He has spoken about his experiences with loss, addressed issues around self-esteem and anxiety, developed coping strategies for when in distress, and has even been willing to explore the reality of his delusional beliefs.
Oliver*, a 52 year old man, was diagnosed with schizophrenia in his early 20s. He had also experienced low mood for most of his life, was living with persecutory delusions of varying intensity for many years, and had his first hospital admission at the age of 22. Since then he has had at least seven prolonged admissions to acute psychiatric hospitals.
Although treated with depot medication, his condition proved complicated to manage in the community, showing a pattern of disengagement, medication non-adherence, recreational drug use and acute decline in mental state, leading to heightened paranoia, aggression and suicidal intent. Over time his condition become more treatment-resistant.
His most recent admission came after an acute-on-chronic decline in his mental state, which resulted in him walking out of his residential community placement in a state of heightened paranoia. He was stabilised in the acute hospital before being transferred to Priory Hospital Solihull, for inpatient rehabilitation.
He had never been considered for rehabilitation before because it was felt that he was too unwell to engage with a therapeutic programme, and indeed the first 12 months of his admission warranted a focus on continued stabilisation of his psychosis.
He was placed on clozapine before sustained refusal necessitated a change in his treatment. He has since been stabilised on a combination of depot and oral antipsychotics, alongside a mood stabiliser.
At first he remained acutely unwell, holding delusional beliefs of a bizarre and paranoid nature, whilst reporting hearing and seeing strange things in his bedroom during the night. Yet over time, as he has developed more trusting working relationships with staff in the hospital, we have been able to support and redirect Oliver through periods of distress.
He now accepts nursing help to manage his personal care, and we have seen improvements in his personal hygiene. He has gradually progressed to taking unescorted leave, and leaves the hospital most days to do his shopping or engage in his hobbies such as cycling, country walking or fishing, all of which are available within a close distance of the hospital. He has been self-catering and, with the support of our occupational therapy team, can now manage a weekly grocery shop to meet his needs. Although isolated for most of his life, we have seen Oliver develop friendships with some like-minded peers and we have supported him to visit some of his friends after they were discharged to the community.
We are particularly proud of Oliver for how he has been able to engage in the psychology programme. He has developed a trusting relationship with his therapist and talks honestly about his feelings. He has spoken about his experiences with loss, addressed issues around self-esteem and anxiety, developed coping strategies for when in distress, and has even been willing to explore the reality of his delusional beliefs.
Oliver’s chronic illness is unlikely to ever resolve, and he lives with both positive and negative symptoms every day. While there is still much more to be done before he will be ready to leave hospital, we are delighted at the relationships he has formed and the relative independence he has developed during his stay at Priory Solihull so far.
*Name changed to protect identity