CASE STUDY
Supporting a Young Person with Mental Health Concerns
History of the Young Person
The young person (KA) had made several historic allegations against her father and another known friend of her father, these incidents were alleged to of happened when she was under 18 years old. Police investigated these and there was no further action taken.
KA placed herself at risk by talking to unknown males via chat rooms or social media, she had also shared indecent images of herself. KA was vulnerable in the community and would engage with conversations with unknown males, she has in the past given her number out to men on the street.
KA had made allegations about an ex-boyfriend stating that he and his friends assaulted her and burnt her stomach area. She was supported to make a disclosure but would then not engage with the process.
KA also had a significant history of self-harm having previously tried to take her own life, as well as tying ligatures around her neck. Her self-harm often increased when she was in psychiatric units. KA had ligatured 4 times in the placement prior to coming to an LCS supported accommodation environment.
KA had been admitted to A&E on several occasions and this resulted in her being admitted into various psychiatric units. She had also been detained under the Mental Health Act under section 2, approximately 4 times.
When she was living at home there were concerns about her parent’s ability to safeguard and manage the risks to KA. The choices made by her parents have been against professional’s advice at times and when KA returned home there was often an increase in her self-harm.
From the age of 14, KA had a history of accessing mental health services. She was admitted to a mental health unit and then moved to another mental health unit after presenting with eating disorder type symptoms. Following discharge, KA had several further admissions to inpatient units following overdoses and her inability to keep herself safe in the community, this took her away from education, family and friends.
Prior to being accepted onto our LCS programme, KA did have a period of stability in a placement. However, she had several A&E admissions for self-harm or allegations of self-harm; attendances were not always because of actual harm to self, but concern from staff around her escalating behaviour. She was assessed at every attendance to A&E by a mental health practitioner and a plan of discharge was made with KA and her placement. Discussions had begun around a diagnosis of possible Emerging Personality Disorder; these were taking place with her CAMHS nurse who she saw fortnightly.
Moving to LCS
We were approached by a Local Authority who felt that KA’s current setting was not supporting her needs and that a placement within LCS would improve on this. The Patch Manager from LCS went to visit KA and spoke to her about semi independence and what it might look like for her – KA was very negative and refused to speak, sitting in a tight ball and rocking.
KA felt that no services could manage her and that a move to semi independence would be too much for her. It was apparent very early on that KA wanted to be a child still; she was scared of succeeding in semi-independence as she was frightened of losing the professionals and services around her once she turned 18 years old.
We worked very closely with a psychiatric hospital, CAMHS and the Local Authority – joint meetings were held and all agencies worked to minimise the risks that KA presented with. A multi-agency risk assessment was developed and signed by all parties. As part of the multi-agency work it was important that as a provider we were well supported in helping KA. It was agreed that both Children’s Services and CAMHS would meet with our placement staff weekly for support and guidance.
We all acknowledged that there were risks of harm to KA, but there were going to be risks wherever she was placed due to her chronic self-harm. At the time of assessment for LCS, KA was not expressing any suicidal ideations or intent, however, it was acknowledged that she could act impulsively when overwhelmed with emotion and lead her to undertake risky self-harm - which could result in death by misadventure.
It is important to recognise that as a semi independent provider our aim is to work alongside the YP to ensure that they will be able to be part of their local community and conduct their life as safely and as positively as they can whilst working towards independence.
It is acknowledged that for young people to transition from Children’s Services to Adult Services, the threshold has increased - LCS focus on ensuring that we are able to provide the evidence that is needed to support this process. Our goal is to ultimately see the young person living independently, but in some cases it will be about supporting a move to Adult Services and a thorough transition.
How we worked
Staff supported KA and encouraged her to make any disclosures or allegations to the police independently in order to reduce the risks of this being shared third hand and information not being passed on fully.
Staff supported KA with internet safety over weekly sessions – she eventually agreed to be open and honest about her internet use and shared this information with staff which then led to more safety planning.
Child Line were informed of the placement address and provided with contact numbers of staff supporting KA. KA would contact Child Line for support and help so this safety plan was put in place so that staff could assess the situation and determine if she needed medical attention.
LCS support staff explained to KA the concerns and consequences of ligaturing, challenging her actions should she decide to tie a ligature. KA understood that moving to semi independence was her chance to regain some control in her life, have therapy and be supported.
LCS assessed that KA would not need 2:1 staffing or a waking night – this type of intervention clearly had increased the level of KA’s self-harm in the past and in our assessment we evaluated that this behaviour was in fact KA testing staff. LCS wanted to break this cycle of behaviour by supporting KA to make her own positive choices.
Positive Outcomes
KA’s referral was completed and she was supported with her assessment and transition into the programme. KA was given Dialectical Behavioural Therapy and she joined the high risk self-harm group, she attended twice weekly and staff worked with KA until she was able to maintain this therapy fully independently.
Although staff were not able to administer any medication, we installed a lockable cabinet in the staff room and KA needed to identify what medications she needed and at what time each day – this began with prompts and very quickly KA managed this herself. At the hallway point of the programme, KA was not on any medication and her coping strategies were practical rather than reliant on medications.
KA had strong views on her time as a looked after child, what worked well and where she saw downfalls in the service. She was supported to find her voice and she joined the Children in Care Council working her way up and into the Young Commissioner’s. KA has been a very active member and been responsible for some excellent changes for young people.
KA was supported to return to education and complete some qualifications with an informal provider, who nurtured her learning and her anxieties. She was very successful and secured a place on a health and social care apprenticeship within the Local Authority.
Being alone was a key theme for KA and for many of the young people we have in our service. Accepting that as an 18 year old they are no longer a child being looked after can be very hard for young person to accept. Empowering them to access support in their community, make meaningful friendships and have an active life is the grounding of a good transition into adulthood. We supported KA in ensuring that she had a plan of who and what she could do when she needed some extra support.
KA became a young adult who was able to cope despite her mental health concerns. KA formed coping strategies that helped her through and by completing her programme at LCS she could live independently. She was able to embark upon our step down programme and slowly, staffing was reduced. At each new step we held multi-agency network meetings where KA would be present and have her say. KA eventually left LCS after successfully bidding for her own Local Authority accommodation.
LCS were happy to offer a transition programme and KA was supported in settling into her new flat, setting up her budget and furnishings whilst having a named worker come and visit her.