George

George, 56, has moderate learning disabilities and autistic traits. He spent 37 years – more than half his life – in three secure hospital placements and institutional-style residential care.

George has a history of sexual offending and borderline personality disorder, which makes him emotionally unstable. At his most recent hospital unit in the south of England, George was known for targeting staff with bouts of verbal aggression, often continuing for up to 24 hours. Over one six-month period, staff at this unit noted around 68 incidents of verbal aggression. Made to apologise repeatedly until the person he had verbally abused felt ready to accept his apology, George became confused, apologising for everything all the time without understanding why. He was allowed out once a week for shopping, but only if he had run out of snacks. He would compulsively eat everything he bought immediately on return, knowing this gave him a chance to go out the following week.

George’s current support provider was selected via a local framework agreement designed to support people to move out of secure placements. Initially, some clinicians were sceptical about community support for George. The provider had to work to build trust with them to secure his discharge.

Planning for the service took place during the pandemic, and much of the transition was managed digitally. This meant the provider’s staff had to get to know George virtually, as Covid restrictions prevented ward visits. Through this virtual contact the provider’s transition team identified George’s interests and used a less traditional recruitment process to find support staff with similar interests. This meant that George had an instant rapport with his team, which has reduced his angry outbursts.

Once appointed, George’s new staff undertook bespoke training, including Positive Behaviour Support, before he moved into his new home. His property was designed just for him. He chose furnishings, the colours of his rooms and asked to buy a shed so he could start learning woodwork. After a year of preparation, George moved into his detached cottage at the end of 2020. When he arrived, the house already looked and felt like the home he had always wanted.

Since then George and his team have been getting to know each other better. His staff adapt to his changing requirements by listening and responding to his leads. The provider’s senior Complex Care Lead supports and debriefs staff as needed.

George’s team understand that his aggressive behaviour is his way of communicating that he is distressed and is also sparked by a failure to meet his needs. The support they provide is designed to learn and adapt accordingly and staff use de-escalation techniques to manage outbursts when they occur.

After years of living in institutions, George expected punishments like losing the privilege to go out and was constantly on his guard. However, since leaving hospital, George has not been physically restrained or punished by having things taken away from him. Staff continue to support him to understand that he has choice and control over his life.

In the first month in his new home, the incidents of verbally aggressive behaviour fell by half. There were just six incidents in a month, lasting an average 30 minutes each.

As he can help himself to snacks at home and goes out every day, George doesn’t hoard food or binge eat. The first night in his new home, he asked staff to help him make his favourite meal, sausages and mash. He now collects recipe cards and wants to learn to make a pavlova.

He exercises daily, visiting the coast at least once a week, which helps his mental health.

George’s two-to-one 24 hour support has enabled him to explore new interests like woodwork. He is currently designing a wooden guinea pig pen and looking forward to owning a pet.

Not long after moving in, he rang a friend he made in the secure hospital to tell him how great his life is on the ‘outside’.