Diane, 38, who has a learning disability and a mental health need, spent 16 years living in secure hospital care and tried to take her own life many times.
"I felt like there was no hope," she says of her self-harm and attacks on staff. Driven by despair and frustration, Diane injured herself "to get away from the feelings and the thoughts".
She recalls how staff, who regularly restrained her, warned that she would never survive life outside the hospital unit:
I was often bullied by staff and spent a lot of time in seclusion in high and medium security. I thought I’d never get out. Whenever I thought I was getting closer to leaving, staff would make me ‘kick off’ and they said if I ever left, I’d be back in six months.
A provider, working in partnership with the local authority and clinical commissioning group to develop services in response to Transforming Care, agreed to look at Diane’s case. There followed five months of meticulous preparation. This was led by the provider, which assembled a wider team including a psychiatrist, a psychologist, an occupational therapist and a counsellor.
There were several potential barriers to Diane moving. The provider had to review its approach to risk, convincing colleagues that working with adults with complex histories was safe and deliverable. Also, trust with clinical partners had to be established. Diane, the new provider and other professionals involved recognised that planning for Diane’s future had to involve acknowledging her past. Together they created a transition plan, taking into account their understanding of previous placement breakdowns.
The staff identified to work with Diane were recruited to reflect her interests. They spent time getting to know her before she was discharged, visiting her on the ward and finding out what she liked to do so they could build a support plan that would accommodate this. They also supported Diane to visit her new home. The idea was to create a home where Diane would be as comfortable as possible as soon as she moved in, supported by people she already knew well.
Support staff were trained to meet Diane’s requirements. In addition to mandatory induction, they received Positive Behaviour Support, suicide avoidance, self-harm, mental health and autism training. Managers and the wider multidisciplinary team supported both the transition phase and ongoing management of Diane’s care, providing additional help as required.
Diane left the hospital eight years ago and has never looked back. The first few months were challenging. Diane took time to settle, but her team were highly motivated and determined to help her succeed. Over time she became comfortable and happy in her new home.
Diane lives in a supported living flat close to where she grew up. Although she initially had 14 hours support a day, with two support staff, she now needs just five hours one-to-one support a day and has not been restrained since she moved. Her current placement costs £100,000 a year – a fifth of the £500,000 it cost in the hospital unit.
More confident and independent, Diane takes the bus on her own and, for the first time in years, visits her family alone. She enrolled at college six years ago to study maths, English, an independent living course and basic computer skills. During the pandemic she was learning online like most other students. Diane has done paid work through her support provider, acting as a consultant delivering training sessions to health and social care professionals about her experiences.
The approach of Diane’s support team is key to how her life has been transformed. Staff play a vital role in offering Diane reassurance, acting as a trusted sounding board to keep her emotional and mental health in check.
"I feel like I’ve got a life now," says Diane of her experiences since leaving institutional care. "It feels better because it feels like someone cares about you…I’m thinking positive instead of negative."
Key actions that made a difference:
- Understanding Diane’s past to help plan for her future.
- The provider reviewed its approach to risk.
- Support staff got to know Diane before she moved.
- Making sure Diane lived close to home.