1. Placement Monitoring Team: Interventions & Observations of a Lambeth Case Study Heidi Emery MHLD Placement Coordinator Placement Monitoring Team (PMT) MHLD Services South London and Maudsley NHS Foundation Trust NHS Foundation Trust

2. Background for Out of Area Service Users Service Users – Learning Disabilities, Mental Health/Complex/Forensic needs. Majority subject to Mental Health Act (2007)or complex MCA issues.In Medium, Low Secure Units / Specialist Community placements > £100,000 per year but < £ 200,000 in most cases Long term input required due to complex needs and requirement for creative and complex rehabilitation programmes

3. Case Study: Female. 45 years old. Diagnosis: Mild LD, Bi-Polar Affective Disorder, Autism and Epilepsy. 11 Years placed out of area. 11 Years held under MHA 1983 Section 3. No forensic History, though high level of care staff assaults.

4. Initial Assessment – a picture of some issues :  No display of picture easy-read service user information on the ward  Copies others' behaviour and wants attention approximately 4 times an hour  Unsettled since Christmas when her mother went away on holiday and was subsequently unable to come and see her due to bad weather in the winter.  Misses out on activities due to aggressive and unpredictable behaviour  No relationships with her peers and only the qualified staff.  No interaction with community-based projects only going out for walks and meals with two escorts.

5. Example Concerns from Initial Assessment:  Care plans had remained the same since early in the admission except for seizures plan which was discontinued.  No up-to-date assessments of her psychological presentation and assessment of her IQ.  Little change in ward round monthly records.  No clear planned evidence of discharge planning.  Living skills and lifestyle management/rehabilitation not a focus of the admission.  Minimal Occupational Therapy input and when activities stopped they were not readily replaced.

6. 12 months later, PMT take on the case:  Placement was very inflexible with organising dates for meetings so all parties could attend.  Little change from previous assessment 12 months ago.  Lack of recognition that suitable treatment options were not available.  MHRT directions not adhered to with subsequent ruling to move to an alternative placement.

7. Placement Reported to CQC on the following concerns:  Family not invited to S117 discharge planning meeting.  Placement ignored recommendations of transition plan.  Belief that having 3 patients on the ward with learning disability equated to providing an LD service.  No appropriately trained staff to provide such LD service.  Poor and defensive communication with external parties when rationales questioned.

8. Future for the Service User:  She has moved to a hospital where her LD and Autism needs can be met with appropriate treatment options available.( Placement is now in London)  Family are engaged.  Care pathway being considered as an ongoing issue, and opportunities for rehabilitation into the community being planned for  Some incidents but less in severity and patient appears much happier.  High level of Psychology input.

9. Further Information: Please feel free to contact me to discuss any issues in this presentation: Heidi.Emery@slam.nhs.uk Tel: 07800662407