Undertaking a risk assessment with a young man with mental health problems & a learning disability

I can't make any sense of him were you able to establish contact with his key worker no out on a visit with another client she has been trying to get him seen in the community apparently and from what I've been able to find out things have been going wrong for a few weeks at least I see the police have agreed to wait outside because he became so disturbed when they were in the room but I'm a bit concerned about going in unless they're on the premises yeah but he can't stay here is not appropriate and we don't have the staff just talking with my colleague Tim yes this is Paul he's the ward manager here I have to go home now well see about that in just a moment we're gonna get the bus let's sort a few things out first time if you're not Tong who are you Tom Tim it's Tim isn't it you remember me I'm dr. Lewis I'm a psychiatrist when the police brought you here they explained that I needed to talk to you about a few things no they can't go yet I'm a doctor I need to examine you find out what's wrong okay Tuesday there are no buses and whose bill is that your make no he's here he's here I'm not sure he was saying something like that before whose bill is he saying he's got a fever well maybe he's got an infection perhaps one of the nurses could do some ABS on him how we're gonna take his temperature while he's like this Tom Tim I don't understand what you're saying it doesn't make any sense to me why did you barricade yourself in your flat when the police came and why did you flood your barter in the day before what's been happening for the past few weeks this if that's possible Tom what's possible and where's bill if we can speak to him the police might be able to help us oh oh sign the papers and I'll chase up a social worker and I think he needs to go to the PQ you Tim are you still worried about the police being in the building yes your neighbors were concerned because your flat became flooded a neighbor called the police because they wanted to help you but they couldn't get into your flat and the police brought you here so I could talk to you I'm going to try and help you Oh favorites they're all favorites there or fever I don't know what you mean when you say that the neighbors woke you sound all feverish they're all feverish there I don't want the place here they have to go Oh farmer bill I know you want to go home but I'm not sure who bill is can I ask you some questions first I don't know what happened at your flat can you tell me what happened I was also told that a very good friend of yours was involved in a bad car accident is that right the neighborhood wasn't sure what was happening there they couldn't get in there's a run big Tim this is my colleague Paul he's bought you a drink would you mind if he joins us hi Tim Randy doe Oh favor is there or favor is there Tim I'm not sure what's wrong can you tell me oh can we get bill for you can he help the team would you like a drink Tim can you tell me what's wrong Tim once again I'm sorry we weren't able to locate you earlier or get one of your colleagues in to help us to be honest we were out of our depth I did a pretty poor job in trying to understand what was happening and in the end we felt we had no option but to section Tim in order to give a fair deal in terms of support and representation also to safeguard him we couldn't properly determine his safety so I felt we should err on the side of caution yeah no don't worry about it I'm just glad Tim's getting some help I mean I don't know if you know but I've been away on leave and just got back this morning and the person who was covering me was off sick so Tim hadn't been seen at all this week so he's just had a whole lot of unfortunate coincidences so the neologisms are normal for him we thought it might have something to do with his psychosis oh no no no he's always been like that just the same as when he repeats things that's been said in early parts of the conversation and he hates to be touched yeah I found that out I am have to finish the risk assessment with him but I think I might not be getting my questions right I might be other complicating them right okay we'll just just keep your questions and your sentences short don't give him too much information avoid pronouns that's that's a good start I mean people with autism find it difficult to take in abstract information or at least too much of it and you were saying that all this started when his friend was run over and killed yeah yeah Tim was with him I mean there weren't close friends but he did actually see what happened but I mean that was about three months ago and he seemed relatively okay at first but it in these last six to eight weeks his behaviors become more unpredictable and and difficult I mean he doesn't go out at all how hardly ever attend the day center doesn't to his part-time job just stays in listening to his audiobooks because he loves The Hobbit but he plays this section over and over again but then he got into an argument with somebody that lives on the block with him and he threw himself out of his wheelchair and nearly down a flight of stairs and well when he does go out if at all he shouts at cars he has some very odd ideas now melis I can't make sense of them and his neologisms are are increasing as he's becoming all worried why did he flood his flat I have no idea yeah but he would have been just terrified of the police he's got this thing about uniforms and and sort of big people you know we may have to convert at section 5 – and keeping me a longer right yeah I mean I have tried talking to him but he's pretty angry with me for not being around whilst I'm all this happened well I better complete the risk assessment and then talk to my consult about where to go next ok um I mean ah well I can today if you want no it's ok for now obviously we would like you to be with them for ward rounds and any key events that's possible yeah and if you could provide us with some guidance about what to do and what not to do practical things like not touching him letting him look after his things the way he likes to yes yes he does like order and routine I know it's probably gonna be difficult but I mean if you could let him know what's happening and when I mean that would be a great help because he is gonna find it difficult to follow what's happening to begin with especially as he's so anxious and has been disturbed I mean if someone's they could draw a map of the ward I mean he really likes things like that or a picture calendar with pictures saying you know what's gonna happen and when I think of one of our eight CAS as good at stuff like that I'll see if I can come up with something anything else really he has difficulty in expressing how he feels and and what he does they gets all mixed up with his neologisms and The Hobbit were like this bill his imaginary friend I don't love you well that's Bilbo Baggins not it so something like a chart or a diagram with pictures representing his mood or what he's feeling can also help oh great where can we get one of those well I think we're gonna have to sit down with him and draw it I'm afraid look I do have a list of things of what he usually does and when and what time I mean if you can follow any of these oh and there there's a few things we're gonna have to cover about his physical disability as well Tim I'm really sorry that you don't like being here I know you want to go home but your flat is being repaired at the moment the flooding has damaged all the electrical things do you understand what I mean things like car CD player where you descent you're talking books aren't working I want to go home I want to go on the bus was Bill I'll help you get home as soon as we can with Bill but the doors to the flat were broken the doors need to be fixed do you understand what I mean we're the folks a favor is there where scholars are they Tim I'm trying to understand how you're feeling do you remember we were talking about that a few minutes ago Oh looking for toys were you looking for toast at home in the flat yes Tim did you burn the toast yes toast and fire you burn the toast in the flat did you turn the water on to put out the fire Oh favorites they're all favorites there I want to go home on the bus with Bill the two five died it's Tuesday okay Tim now we're getting somewhere look I've made this chart would you have a look at it for me it's got lots of faces on with Tim would you have a look at the chart Tim you see the faces there's a happy face there's a sad face this one looks angry this one's confused this one's frightened this one looks tired and this one looks full of energy would you have a look at the faces and tell me which one looks how you're feeling Timmy you frightened are you fight about what happened in the flat with a fire and the water everywhere is that why you barricaded yourself in the flat his curves are inside boy the police here I sent the police away I thought you were safe here Tim are you still feeling safe well the police through what at the flat you mean at your flat why the police there what are the police going to do to you we sent them away do you feel safe a favourites there you're not in any trouble about what happened at the flat Tim the police phone you there because your neighbors wanted to help you the police weren't there to arrest you or harm you the police brought you here to the hospital so we could look after you where's my tea oh okay it's time for your tea and cake I'll ask one of the nurses to bring you some tea and cake if you wait here will that be all right yes thank you you're not in trouble no you're not and why are you having your tea and cake maybe we could carry on talking I'll just be a minute you


  1. Very well portrayed. It is important to understand the baseline level of functioning for a person with a learning disability and/or autism -to distinguish what is pathological and what is normal or usual for the person. And it is essential to adapt both the environment and the communication. It seems that the man being assessed may still be trying to come to terms with the traumatic experience of witnessing his friend’s death and that his flooding his flat after the fire from the toaster was his attempt to keep safe. He is clearly distressed.
    Thank you to our NHS staff who make the effort to understand how to work with people with learning disabilities.
    And thank you to all the actors!

  2. The truth is he spies on them during meetings

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