Paul *

Paul is a 51 year old white British male with a complex developmental, medical, forensic and psychiatric history. For the last 10 years, prior to coming to Harcourt House, he required containment in medium-secure settings under the Mental Health Act (1983). Paul has had numerous diagnoses, including schizoid and dissocial personality disorders, features of Asperger syndrome, schizophrenia and more recently organic delusional-like disorder. His phenomenology involved distorted beliefs about white supremacy, violence, sexual fantasy, persecution and jealousy. The legacy has particularly damaged his capacity to relate safely to females and has given support to a number of delusional belief systems that make him a potential and actual risk to himself through neglect, and to others through verbal and physical aggression.

Paul has few supports outside his immediate family. Before going into medium security, he required considerable support in living in the community.

Paul has been at Harcourt House for nearly a year and has made considerable progress. On arrival he underwent a thorough period of multidisciplinary assessment with particular focus on risk. As a result of the assessment process, Care+ began a detailed rehabilitation programme focusing on:

• socialisation, self care and anger management;
• escorted leave under strict conditions, as part of positive risk taking (he now takes regular trips to the library);
• encouraging him to socialise with the healthcare team and to spend longer periods of time out of his room; and
• participating in orientation groups.

We are pleased to report we have seen no serious behavioural outbursts, although we note verbal outbursts, mostly short lived, and often when Paul perceives being “bossed” into doing something he does not want to do.

Paul's epilepsy is ongoing and warrants further specialist review. We hope Paul will make further progress in self-care and social and physical activity.

* Name has been changed to protect client identity