Forensic Mental Health-*John’s Story's story
John is a 60-year-old male with a primary diagnosis of Paranoid Personality Disorder. He has a background history of alcohol misuse, illicit drug use, anger, and verbal aggression. On 26 February 1992, John assaulted and killed his partner, following a heated argument which started when he accused her of being unfaithful.
In April 1993, John was convicted of murder and sentenced to life imprisonment. He was released after 15 years but was only in the community for six months before he was recalled for breaching the conditions of his licence. Since then, John has served another seven years in prison on three separate occasions, and only eight months in three different placements in the community, all for breaches of his licence, prior to coming to coming to us in 2014.
John was released to our service in January 2014. We worked with him for twenty-six months and he successfully moved into independent living accommodation. However, it was noted that John breached the conditions of his release and was recalled back to prison towards the end of 2016.
John’s second stint with us
John should have been referred to Single Homeless Intervention and Prevention (SHIP). However, when his case was taken to parole in June 2020, our service was given as the only address he could be released to. The intake assessment was carried out and John was placed on the waiting list as there was no available bed space. Consequently, John remained in prison until space became available. He was released to our service in November 2020.
Working with John
On admission to service, John was allocated a keyworker and a link-worker. He was supported by other staff in the absence of his allocated workers. John was provided with essentials on a regular basis until he started receiving benefits.
John went through a period of aggressive outbursts when he first moved into the service, which initially led to a difficult working relationship with staff. This behaviour could however be viewed in the context of financial hardship as he had no income at the time. It was difficult for staff to support John to apply for state benefits due to a lack of formal identification. He did not have a passport, birth certificate or driving licence or anything that could be used as identification. This led to a delay in applying for benefits and the subsequent expression of anger and verbal aggression towards staff, accusing them of not being helpful. This resulted in John often isolating in his room and refusing to engage in any meaningful activities. He was also observed to be increasingly anxious and said he was fearful of being recalled to prison due to his aggressive behaviour and non-engagement with services.
Staff worked with John intensively through one-to-one counselling to address his problem behaviour. He was taught appropriate social skills, which improved his interaction with staff. He became less confrontational and was able to reflect on his behaviour. He was also taught the importance of complying with his treatment plan.
John was supported to get an initial loan from a community service which provides short-term loans while people await their benefits. He was also supported to locate his birth certificate and, eventually applied for Universal Credit. His behaviour improved once he started receiving benefits. He engaged more positively with staff and his care team since then.
John was supported to re-establish his relationship with his ex-girlfriend. This has helped him significantly because he had no social support network, as his only daughter, siblings and friends resented him. He recently requested overnight leave to visit his girlfriend. Following a review of his request by his care team and his probation officer, he was granted overnight leave which is reviewed periodically.
John currently engages in structured activities. He cooks healthy meals regularly and keeps his living space clean and tidy. He is a lot calmer and manages his anger more positively. He also manages his finances effectively. John has not been observed to be under the influence of alcohol, and all his recent random Urine Drug Screen (UDS) tests have returned negative results for all illicit substances.
John has restarted his psychotic medication and is in a stable intimate relationship with his former girlfriend. He is currently having overnight leave to his girlfriend’s accommodation. A referral to IMO has been accepted awaiting bidding number.
John has made remarkable progress in all areas and is a lot calmer. He has stated that his girlfriend has been a great source of support to him. He has expressed his gratitude for the support he has received at the service saying:”…staff cares about me…”
John said he is determined to rebuild his life and stay out of prison as he is no longer a young man. John intends to marry his girlfriend soon.
*John’s real name has been changed to protect his identity.