Professionals meeting

Sadly, Rehab never worked out for Beth due to it not been PICU and more expectation to be independent.

Beth is back on PICU 🤦‍♀️😩

It’s just a vicious cycle

Last week there was a professionals meeting for Beth. These are the minutes ….

asked what is the next step and the wards intentions moving forward, as PICU wards are not autism-based wards. **went on to express her concern with the intermittent observations that Bethany is on. She was asking what the purpose of these is and questioned how helpful these are for Bethany. She stated that the MDT need to understand what the long-term, medium-term, and short-term goals are for Bethany’s care.

• ***stated that she had the same hindering thoughts about autism admissions. She also questioned why there are more incidents with Bethany on ### ward than on the PICU ward. (Beth said she’s used to PICU 😩)

• ****** made the MDT aware that he does not know Beth very well. He noted that some of the support for Beth appears very reactive. ** questioned the reasoning behind Beth’s self-harming behaviours.

• ****stated that it was previously anticipated that Bethany would struggle because of university. Bethany was feeling a sense of loss as her friends were graduating from university and she was not. This was a big trigger for her.

• **noted that the ligature incidents reduced significantly in the PICU wards. She spoke about being aware that university had a big impact on Bethany. However, she said from another perspective that it seems Bethany gets a high from ligaturing and believes that she is not going to stop doing it.

• In response to **, ## told the MDT that he believes there are 2 components to Bethany’s ligaturing incidents. He believes that the ligaturing is a coping strategy for her and that it helps her find a way to regulate and control her emotions into positive directions.

The other component he believes acts as a brake pedal that she can push whenever things go too fast for her. She usually does this in periods when she feels she is losing control.

• (Autism Team) stated that she does not feel like staff are understanding why Bethany is ligaturing. She suggested that any future interventions should be proactive instead of reactive. ** believes that the reactive interventions explain the maintenance of Bethany’s presentation.

•*** noted that there may be some sensory elements to some patterns of Bethany’s self-harm.

• **stated that she is not confident that Bethany’s ligaturing is sensory.

• What the MDT need to do is decide where the safest place is for her to be while staff unpick the ligaturing reason in the background.

(Beth has told me that it is how she communicates to staff when she needs something)

• ****Asked about the reasoning that Bethany’s ligaturing is increased on ## . She suspects that this is because she is closer to discharge at ## and because there are higher expectations of her there.

• **(Advocate) believes that Bethany liked being on PICU because she was placed on 1:1 observations all the time and that she was too reliant on this.

### worked on reducing her observations and Bethany expressed that she struggled with that.

General observations would probably not be enough to keep her safe.

She noted that there has been an increase in violence on 1:1 observations as staff try and intervene when Bethany tries to ligature. Bethany has tried to strangle staff which is a new behaviour.

By lowering the observations to 4 per hour intermittent engagements staff are trying to manage Bethany’s safety in the least restrictive way.

Bethany believes that she needs a level of restriction to help her contain her anxieties about being well. Staff are questioning what being well looks like for her.

***stated that some communication styles and managing of self-harm needs to be reviewed.

Bethany’s strangling of staff has been reported to police.

****agrees that Bethany does not manage responsibility very well. Staff are going to speak with speech and language, and psychology about this. Staff understand that it is going to be a work in process.

***states that it is hard to mature in a restrictive environment where, by default, the patients have little responsibility.

•** (Autism Team) questions whether Bethany is socially able to know what responsibilities she should have at her age. (Beth hasn't learned the skills of been an adult as she was sectioned at 18 and not had the experience, which has been removed from her)

** is looking at doing an intensive Autism assessment on Bethany around the impact of her autism which should be beneficial in filling the gaps of knowledge within her formulation.

•*** learnt a lot about Bethany and building relationships. Relationships with staff are important to Bethany she prefers regular staff to engage in activities with her. She does also need time on her own.

##staff managed this for 5 weeks and it worked well but then she began ligaturing again. It would be helpful for **and the autism team to unpick this.

**also noted that when Bethany is back on the ward after leave she engages in more self-harming behaviours.

• ***recognised that a leave period is helpful. She questions how we focus on the positive elements of her recovery. She suggested that having regular staff working with Bethany should be encouraged.

She also suggested that staff look at moving Bethany to an acute ward. ***reiterated that Bethany needs community team engagement.

•****spoke about Bethany’s Mum’s view stating that in the formulation she made good points, and she sees how well Beth can be when she is with family. Mum is aware of how much being on a PICU prevents Bethany from moving on. Mum has been furious about Bethany being moved here and **** agrees that she is asking a lot of sensible questions and deserves answers to these.

*** understands that Bethany may feel abandoned, and he finds it difficult to tell her that she has not been after long periods of being unwell on ##He states that she needs to be moved to a less restrictive environment, potentially on 1:1 observations at first to take away the pressure of moving and living somewhere else which hopefully will avoid self-harming behaviour.

There needs to be community and autism informed input at all levels.

When she is stepped down staff have to be more proactive in moving her back to PICU if this is needed for a short admission to avoid the staff struggling for so long at ## with her management.

•** suggested that maybe the hospital is not the place for Bethany.

She asked whether anything has been explored in the community.

•*stated that Bethany has been open to a community team for 3 years. She has had changes in care coordinators which may have been difficult for her (Beth’s C.Co have not worked with her!) however university seemed to be her biggest trigger.

Bethany’s mum’s concerns are quite long standing, and this is understandable.

The care coordinator has the impression that Bethany’s needs are very different to her wants and that it is hard to have these conversations with Bethany.

She suggested that the wards need to understand her function.

She encouraged staff to try and start in-reach for Bethany.** believes this will likely be difficult for Bethany, but they need to have conversations about moving on with Bethany. This will increase concern as these will increase Bethany’s risk of incidents.

**suggested trying to do work with mum, maybe some relationship building work. She suggested that in reach work occurs when Bethany is on leave.

Beth engaged well with female staff that she knew.

•** stated that clarification from a social worker would be beneficial. (sw is in another town 3 hours away and does not attend meetings!)

She suggested that ##set social work allocations up so Bethany’s transition can be smoother.

Actions

• Bethany will remain on PICU for now, but a plan will be created. Both wards have a collective responsibility to do what they can to support Bethany.

• Regular catch-up points on where things are going – fortnightly meetings.

• Input from speech and language to explain plan to Bethany.

• **looking at working with Bethany for half a day next and half a day the following week. Then they will look at a plan from an autism point of view with ## and ##

• Start work with community rehab rather than focusing on a move back to ##

•***will start looking at speaking with social worker to start her transition.

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https://petition.parliament.uk/petitions/648053?fbclid=IwAR1kyUFXpldb6TilFi8IJzcX3hpv-ooolb6UDvRT10L8Q5hpFDwvnzPlj7k_aem_AVzlxeTFafrTYMpt1h7YtIUwaHXpAixgMFkIcMs_5iJ-RYQoCSv0qo79pDDJDokoPxo