Michael

Michael, an autistic man of 45, had lived in 10 institutional settings since the age of six – including two hospitals and a residential school. In these settings he was restrained multiple times a week, was on daily antipsychotic medication and had five-to-one support.

His behaviour included kicking, punching and head-butting staff. In one placement, Michael’s violent outbursts led to £25,000 worth of damage.

Yet after moving to a new-build bungalow in the south east of England in 2013, Michael’s life began to change. Within four years he was off antipsychotic medicine, no longer being restrained and his support fell to two-to-one at home, and three-to-one in the community.

Michael’s purpose-built home has an autism-friendly design with assistive technology. It was developed as part of the Department of Health reprovision programme, using capital from the sale of properties that were no longer fit for purpose. Once he’d moved in, Michael felt settled enough to invite his parents to visit, and to visit his family home for the first time in 14 years.

Initially Michael’s parents and support staff were very anxious about the new build. In response the provider initiated a consultation to help understand people’s concerns and work with everyone to resolve them. As time went by, Michael’s family started to see the potential benefits of him having a place to make his own and supported his move.

The build itself was the result of a partnership between a provider, health and social services, and was later on further developed by another provider. A director at the first provider, says: "If there was one word to describe what this housing solution has done for Michael, it’s ‘opportunity’."

The open-plan design of the one-bedroom bungalow is modern and minimal so there is no sensory overstimulation. The plain colours, uncluttered spaces and absence of fussy fixtures and fittings – like curtain ties or visible pipework – create a calm environment. Having external access to the boiler, mains water and electricity means minimal disruption to Michael as maintenance people do not need to enter his property. In previous placements, having unfamiliar people in the house triggered Michael’s distress.

The assistive technology includes infrared movement sensors, so Michael does not need direct support in his home at night. However, staff are onsite just a few metres away. Sensors also detect if Michael has had an unsettled night, so staff are aware that he might be more tired the next day.

One challenge was reassuring Michael’s family that, after a succession of support failures, the new bungalow would be a success. His family was involved in the design and decor, advising on colours and furniture. Aware that a new environment might add to Michael’s anxiety, the moving plan included storyboards showing the process, so Michael was aware and involved.

The bespoke physical environment provided the backdrop for the right support.

The provider recognised that Michael needed people around him who understood how he was feeling. People who would give him space when he needed it and support when he was ready to receive it. Michael’s existing support team was retrained to better meet his needs and requirements. A Positive Behaviour Support lead was based at the service to work alongside the team when Michael first moved in. This person helped create flexible support plans to respond to the initial challenges for Michael living in his new home. Additionally, managers enabled the team to access support and debriefing away from the day-to-day challenges of supporting Michael.

Michael’s behaviours changed significantly and swiftly. Over the years he has been happy in his home and active in his local community. The house is a short walk from local amenities, which Michael frequently uses. He has not been physically restrained once since he left his residential placement.

The current support provider director says: "The joint working at the planning/design stage of accommodation is a key part to the success of this accommodation."