Chris

Chris, now 54-years-old, became an inpatient in his forties after his two previous residential placements broke down. A man with a learning disability, autism, epilepsy and a neurological condition, Chris spent eight years in a hospital in the north west of England. His placement there cost £350,000 a year.

The anger Chris felt at being locked up in a secure unit manifested itself in attacks on staff, with a knife if he could find one. He was regularly restrained and prescribed five different drugs including antipsychotic medication to control his mood. His life was, as one manager at his current support provider says, “extremely limited”.

Things began to change when a provider developing bespoke accommodation for people from the Transforming Care programme began working with Chris. They initiated a planning process, involving hospital staff, mental health professionals and the community learning disability team. This led to Chris moving into a new community service five years ago.

As Chris had a history of harming others, the provider had to work to persuade its own staff and external partners that it was possible to support him safely in the community. This involved agreeing correct staffing ratios.

Chris’s transition plan was carefully developed to reflect the things that were most important to him. There was emphasis on creating an environment that would make him feel most comfortable, taking into consideration triggers for his behaviours. Working with the community learning disability team and clinical colleagues, the provider identified the necessary steps to help Chris move and adapt to his new home.

Chris said he wanted a "quiet and relaxing" support team in the flat he was going to move to. He helped recruit his team, choosing people who shared his interests. Once in post, the team received bespoke training in Positive Behaviour Support, de-escalation techniques, self-harm and autism. This equipped them to understand and respond to Chris’s behaviours and help him manage them. This team worked with Chris over many months – at his own pace – to gain his trust as they discovered his likes and aspirations. They found he wanted to watch his favourite Premier League football team play a home game, go swimming and have a foreign holiday.

Chris now has a season ticket to watch home games and displays his football memorabilia in his flat. He swims regularly – something previously deemed too high risk. Having been on holiday to Gran Canaria, he is now hoping to visit Greece or Cyprus when Covid travel restrictions ease.

Chris is no longer on three of the five drugs he was prescribed at hospital and only needs reduced doses of the other two. He is not restrained.

Since moving back into the community, Chris has had one-to-one care, but his support evolves as his independence grows. At first he lived in a selfcontained residential care flat with visiting nursing support. In May 2020, he moved into a supported living flat, taking his team with him. Recently, Chris has asked if he might move to one of his provider’s other properties. This is a ‘step down’ supported living flat that encourages more independence. Again, Chris has asked to take his familiar support team with him.

His team are supported by the provider’s management team. They oversee Chris’s support, regularly liaising with local commissioners and partners to ensure that his service is not disrupted in any way. They also provide debrief and additional resources to the team as needed.

"He has moved on considerably since 2016," says his support manager, "longer term, he will become more and more independent." The annual cost of Chris’s support is now £100,000, a reduction of £250,000 compared to his previous placement.