Lisa is 62 years old and has a mild learning disability, acute transient psychotic disorder and emotionally unstable borderline personality disorder. Her first admission into services was when she was 18 years old in 1977. Since then Lisa has spent time in various levels of security prior to transferring to a private sector medium secure service out of area then on to the low secure ward with the same provider.

She was in hospital on a restriction order after a couple of offences, one of which was an offence of arson. Lisa also experienced times of hostility directed toward others often associated with anxiety in relation to the environment around her.

A difficult childhood had meant Lisa had suffered significant trauma, witnessed domestic violence from a young age, and her father was in prison serving a life sentence for a serious crime. She has no family contact and has had limited engagement with treatment over the years.

When discussions started about getting Lisa discharged she told staff she just wanted to live in her home area in a bungalow where she could go out when she wanted.  To add to the challenges of finding Lisa the right home the area she wanted to go and live in was more than a 100 miles away from where she was detained, meaning there were differences in working practices across the different localities and cross working between the NHS and the private sector.

Added to this a limited availability of providers in the area, limited accommodation and a global pandemic meant that it took more than two years from starting the discharge discussion to her actually moving into her new home.

During the planning and the search for the right home, Lisa was involved throughout, using Teams was an invaluable resource to be able to have these meetings and enable Lisa to be involved all the time.

How did you overcome the challenges?

• Asked for an independent review of Lisa’s needs to support the pathway, consider home area low secure, rehab and community services.
• Held weekly senior leadership team meetings to consider what could be done as a system to support Lisa’s discharge.
• Made sure we had involvement with the home area’s specialist forensic community team.
• Used Microsoft teams for professional meetings and weekly meetings between Lisa and the secure outreach and transitions team to catch up and build relationships while face to face visits were restricted because of the pandemic.
• Made sure that home area social workers and nursing and occupational therapists from the secure outreach and transitions team were able to assess the suitability of properties and providers based on Lisa’s needs identified in the service specification.
• Viewed various accommodation options and discussed the pros and cons of each option together.
• Made sure that multi-disciplinary team members working at the private hospital where Lisa lived were able to work closely with the new providers to make sure Lisa’s needs would be met.
• The secure outreach and transition team were able to review documents reflecting how Lisa’s risk had reduced over the years and how Lisa has matured, as well as understanding the impact of her physical health decline.
• Lots and lots of emails to ensure that all members of the team were up to date with the plans – these discussions were essential to ensure that the transition was kept on track, and that things were done in a timely fashion.
• Staff training “getting to know me” work with Lisa developed with the secure outreach and transition team nurses on the teams meeting and delivered face to face to the provider staff.
• Finding a provider who was willing to work with the distance and travel to assess and build relationships with Lisa.
• Support from Lisa’s solicitor throughout with legal requirements including MOJ.

By working together and making sure that everyone was kept updated Lisa eventually received a conditional discharge which meant she was able to move into her new home.

One of the first highlights of no longer being in hospital was a trip to see a fireworks display.

For more information contact dianestevens1@nhs.net

*name changed to protect patient’s identity