Homeless Step Down Pathway Case Study 3

John (name changed) is a 56yr old, single, street homeless male who has a significant history of addiction to inhaling lighter gas and alcohol. He had been admitted to hospital after accidentally setting himself on fire while using gas, which resulted in significant burns to his legs and pelvis area. He remained in an acute inpatient hospital for 3 months receiving treatment. The treatment included skins grafts and a stoma was fitted as his bowels where also damaged by the fire.

Once John was at a stage where he was able to continue healing but not well enough to return to the community he was referred to Mildmay on the detox pathway for 12 weeks. The aim for this was to start addressing his drug addiction issues and to provide on going burns care.

John initially struggled to settle here and was often aggressive with outbursts of angry and abusive language. He often talked about having violent thoughts and voices that tell him to harm people. The people that he had violent thoughts towards could be anybody in his immediate surroundings to a person from his past. The MDT regularly discussed concerns and reviewed the risk assessment regarding the violent thoughts and potential danger to himself and staff. It was agreed that as he was able to explain when he was having these thoughts, staff were able to maintain a safe distance when he was in a heightened mood but able to continue to work with him.

He was keen to talk about his history and went into great detail about his experiences. While John talked about something that had happened in the past his mood often became elevated and he expressed himself in a way that showed a high level of emotion that had not seemed to have reduced over time. It was like the event had happened yesterday. This appeared to be very stressful for him but he explained that talking about his story was helping him to understand the things he has been through.

John engaged well in the Relapse Prevention Group and has attended every session. It was evident that John wants to address his issues and has made an effort to understand the topics. He explored his drug using history and worked on developing other coping strategies that could help him make more positive choices in the future. He also engaged very well with mindfulness practices and he explained that having a direction for his thoughts reduces the negative thoughts he has.

In addition to drug and alcohol support he also engaged with the Mildmay psychologist who explored more skills that could help him manage his anger.

Over the time that John has been here at Mildmay his aggressive behaviour has reduced significantly. He has begun to learn how to communicate in a more assertive way so that he gets a better outcome than aggressive. He also feels that going to rehab is a real option, now that he is more able to manage his thoughts. Also, being around other patients here has benefitted him in that he has had an opportunity to develop the ability to interact with others in a positive way. His family has also started to re-establish their connections with him, which he feels very happy about. Having his family around him has given him extra motivation to address his addiction issues.

As a result of John’s progress here at Mildmay, his external service key worker has recognised this and has felt able to refer him to traditional residential drug and alcohol rehabilitation which has been something that John is keen to go to. This had previously not been an option due to John’s aggressive behaviour.

The plan is that John will be having his stoma reversed in the next few weeks, in an acute hospital then return to Mildmay for a recovery period of 2 weeks. He will continue with the addiction work while he is here until he has an admission date for rehab. Coming back to Mildmay after the operation will allow John to be in familiar surroundings with staff that he has developed working relationships with, which will increase the likelihood of a smooth transition to rehab.

Theresa Hibbert

Drug and Alcohol worker

Mildmay Mission Hospital