Andy

Andy, 30, is autistic, and has a learning disability and an anxiety disorder. In a seven-year period from the age of 18 he was sectioned twice, spending six of those years in several specialist hospitals.

Although during this time he had short spells with his family in the north of England and in supported living, these failed within months.

When under section, Andy would try to strangle staff or rip radiators from the wall when his anxiety spiralled. He was restrained multiple times a day by five staff holding him to the floor, and was prescribed four different drugs to control his behaviour. He was the kind of person, one social worker told his current support provider, who would be "lucky to last six months in the community".

Following several failed placements, Andy’s current support service was designed from scratch to meet his needs. This took time, due to multiple challenges, including:

• securing adequate funding
• finding the right property
• developing a transition plan agreed by all partners
• completing hospital discharge processes.

To ensure the best possible chance of success, the new provider worked closely with the multidisciplinary team, maintaining regular contact. This team identified Andy’s requirements and designed his support accordingly. Using a values-based approach, the provider recruited a new support team to reflect his interests and aspirations. The aim was finding the right people to give Andy the best possible chance of succeeding in his new home.

The new team were trained to support Andy to manage his anxiety. They also received customised autism training to help them understand and respond appropriately to Andy’s needs. They worked hard to get to know Andy well, working alongside clinical colleagues on the ward to build a trusting relationship.

Eighteen months after his initial referral, Andy moved into his new home.

Five years on, Andy now lives in his own house a stone’s throw from his family home, with two-to-one support. He is a member of a social club, is part of a radio enthusiasts’ group that meets at the local pub and is a regular at club nights for learning disabled people in his town centre. Although most of these events moved online during the pandemic, he has been visiting a local park he remembers from his childhood and enjoying trips to the seaside.

Andy is now on the lowest dose of two of the four medications he was on before. Instead of restraint, his staff use techniques such as de-escalation, distraction and redirection to help him feel calmer and avoid potential violent outbursts. For example, if Andy becomes anxious, they might withdraw from the room to give him some space while continuing to talk to him.

‘What comes next’ strategies like a sequencing board and daily planner help Andy feel prepared for and in control of his days. This reduces his anxiety and provides him with structure, which he welcomes.

Managers support the team using clinical supervision and reflective practice. This provides staff with space to talk about how they feel and any issues that may obstruct supporting Andy well.

Fundamental to Andy’s care is the way his support provider has built a relationship of trust with him. This involves going at a slower pace (with new activities, for example) that suits Andy. It also means constantly reassuring him that he is no longer in an institution and does not need permission to do things in his own home. Initially after moving in, Andy would ask permission to use his own toilet.

This approach means Andy feels more relaxed and comfortable in his home and his personality and sense of humour are starting to emerge. He has, for example, a repertoire of impersonations that includes good-natured impressions of his staff. He is, as one of his support workers says, "a natural mimic and a joker".