CPQ REPORT- 30/12/2009
NAME:
DOB:
ETHNICITY:
DIAGNOSIS:
CURRENT LOCATION:
DATE OF ADMISSION:
CARE MANAGER:
CARE CORDINATOR:
The Community Placement Questionnaire is designed to assess the needs of longer-term psychiatric patients. Its aim is to provide a summary of the person’s everyday living and social skills and of any behaviour, which might create difficulties in finding and maintaining an appropriate placement in the community. The conclusions of the report should be used as recommendations and a guide to the general level of support they are likely to need, not as a commitment to a particular placement.
INTRODUCTION
The initial assessment was carried out in 2008, at which time X was felt to be appropriately placed. Subsequent to this, regular contact was maintained with X’s care manager to monitor his progress. Improvements in his mental state has recently been reported hence this review to reassess his needs.
This reassessment was commenced on----- and is based on:
1.
A brief meeting with X on ------
2.
A meeting with his key nurse and
3.
Discussions with his care manager
Information in this report was also obtained from CMHT summaries and hospital case records, in particular a risk assessment dated ------- completed by-----.
BACKGROUND
X is currently on a 15-bedded single sex ward at a low secure hospital in London. He was transferred there from ------, I believe following the recommendation of a Forensic
Psychiatrist.
PERSONAL HISTORY
X was born and brought up in London.
His parents separated when he was young due to alleged violence in the relationship; he was subsequently brought up by his mother. For a period, it was reported that his father was not allowed unsupervised access due to his violence.
At the age of 15, X got into trouble with the police for stealing a car. Following this, his mother refused to have him back therefore he was accommodated in a care home. This lasted a few weeks and he later left to stay with his father with whom he had had little prior contact.
1

X apparently found this living arrangement stressful, given his father’s alcohol misuse which was not acknowledged.
He (X) subsequently had a further move into temporary accommodation before eventually getting his own flat.
In terms of education, X attended a local school until the age of 16 but was asked to leave because of his disruptive behaviour. He left with no qualifications.
Prior to X’s current admission he lived in a one bedroom council flat and found living on his estate difficult. He reported experiences of racism, while his neighbours complained about his constant disturbance with loud music late at night; the latter resulted in occasional warnings from the council.
There were also on going difficulties with his landlord regarding rent arrears and nuisance.
X has had difficulties coping with independent living.
FAMILY HISTORY
X father recently died; though the relationship was fragmented in the past. Prior to his death, he appeared very committed to supporting X.
His mother, who apparently has a hearing impairment, is around the age of 43 and a previous report noted that she works for the local council.
X has two siblings by his mother; I believe they currently live with her.
PSYCHIATRIC HISTORY
January 2005 (age 20): first referred to mental health services by his GP who reported that X had disclosed two incidents of self harm: overdosing and cutting his wrist in
2004. There were also reports of paranoia and hallucinations. (At the time there was evidence of significant drug and alcohol use).
January – June 2006 (age 21): first admission to hospital. X was arrested at home for alleged harassment (over a 4 month period) of a female receptionist.
November 2006 – February 2007 (age 22): Arrested for shoplifting sandwiches with associated delusional ideas; he was later detained under section 3 MHA 1983.
May 2007: informal admission after self presenting to A&E with voices and complaints of inability to cope at home.
June 2007: ten day admission after self presenting to A&E.
ACCOMMODATION HISTORY:
It appears that X was living in his own council flat prior to the start of his current admission in July 2007. As noted earlier, there was evidence that he was unable to cope with independent living.
PAST MEDICAL HISTORY
No significant medical problems. No food or drug allergies.
2

DRUG & ALCOHOL HISTORY
 Started smoking cigarettes age of 14 and reportedly smokes more when he drinks alcohol.
 Conflicting reports re when he started using alcohol (age 12 or 16). During his heaviest period, he consumed six or seven cans of beer (4-5% alcohol content) each day for one to two months.
 X started to smoke cannabis at the age of 15 and smoked two to three joints per day thereafter. He has taken ecstasy and cocaine in the past.
FORENSIC HISTORY
 At the age of 15, X came into contact with probation and the criminal justice system. It is reported that he stole a car and drove it into a police car. He was also arrested for criminal damage to a building.
 Convicted of a Burglary that took place in June 2005 (age 20). He was given one year community probation but was in breach for failing to attend on occasions.
 Arrested in January 2006 (age 21) for harassment of a female receptionist
RISK HISTORY:
 X GP reported that in 2004 (age 19) he cut his wrists and “some time before that took an overdose”.
 X reports being thrown off a college course in late 2005 (age 20) due to an incident involving a female receptionist he had been “trying to chat up”. He explained that he thinks he was falsely accused of harassment.
 In January 2006 (age 21) X was reportedly angry and destructive, smashing windows and throwing things around his flat.
EVERYDAY LIVING SKILLS:
X is able to shop for personal items and manages his money independently.
His cooking ability has not been assessed as food is provided on the ward. However X claimed that he can cook and as a result, has declined cooking sessions with the ward
Occupational Therapist. Staff members are of the opinion that he is able to prepare simple meals independently.
X was reported to maintain a clean and quiet personal space without prompting.
However there was evidence of neglect in the past, I believe this was when he was untreated.
X is able to use all forms of public transport independently. He is currently detained under section 3 MHA 1983 hence requires section 17 leave to go out.
His current leave status is three hours daily in addition to weekend leave to his mother.
SOCIAL FUNCTIONING:
An improvement in X social functioning was reported. Previously he isolated himself in his room but in recent months he has spent more time in the communal areas of the ward. This has however reduced recently due to the arrival of new acutely ill patients to the ward (X prefers a peaceful environment).
He attends the basement activities (pool, TV etc) weekday afternoons and stays for the entire session, most days.
In addition, he has three hours unescorted leave on weekdays which he uses to go jogging and sometimes to cafes. He informed me that he sometimes travels to…….. to jog along the canal.
3

On weekends (Friday evening to Sunday evening) he has weekend leave to his mother; both X and staff members reported that this has been going very well.
A marked improvement was also noted in his interactions with others. Though he still appears guarded at times, his key nurse reported that he is now able to appropriately seek support from various staff members when troubled by symptoms. He often initiates conversations with staff; however, with patients he is friendly but the interactions are brief as he was described as a private person.
SELF CARE:
No problems reported in this area.
In terms of getting up in the morning, he was reported to have mild difficulty as he sometimes needs prompting. There is a daily communal meeting at 9.30 a.m. which he has to attend in order to get his unescorted leave; staff believe this might be the motivator.
MEDICATION:
X medication is administered by staff. Despite ongoing issues about his insight, staff reported no problems with compliance.
When I discussed with X, he initially revealed that he is compliant because he is being treated under the MHA 1983 and has no choice. He stated that he does not think he needs medication nor to be in hospital. When asked what sort of hospital he was in, he said it was an ‘NHS’ hospital.
We discussed further and I felt there was a slight shift in his ideas about medication compared to October 2008 when I first reviewed him. I enquired if he would take if not detained; firstly he said no but then indicated that though he would be reluctant, he would take it if he was advised to do so.
He is currently prescribed:
 Olanzapine 10 mgs daily.
PRN medication was prescribed but not administered for over a year. I questioned the justification given that there appeared to be no clinical need for it. This issue was raised at my previous review in October 2008.
INCONTINENCE:
N/A
CHALLENGING BEHAVIOURS:
In the context of his hospital detention, staff reported no major problems in terms of socially unacceptable behaviour.
X is currently detained under the MHA 1983 and though he continues to hold delusional ideas, over the last year his mental state has improved. There have been no reports of verbally or physically abusive behaviour. There is past evidence of some physical aggression, however, he does not appear to have a serious history of violence.
X continues to hold delusional ideas. While his ideas about the TV presenter with whom he thought he had an “on/off” relationship, has lessened, he continues to hold religious delusions in the form of communication and messages from God and the belief that he is on a mission from God to make peace in this world.
X also had delusions about the royal family and in the past frequently visited
Buckingham Palace. On one occasion he told the guards that God sent him to make sure
4

that the Queen was safe. The hospital was subsequently alerted and X has been asked to refrain from visiting the Palace. There have been no further reports hence it is assumed that he is adhering to this restriction, which he confirmed with me.
ADDITIONAL IMPAIRMENTS:
Various reports have noted that he is guarded hence there are difficulties assessing his mental state; this was also my experience. Staff reported that this occurs to a lesser degree presently. There were no reported problems with concentration.
X continues to hold delusional ideas but psychologically, his ability to carry out daily tasks no longer appear to be significantly impaired.
In terms of relationships with others, X recently lost his father who was very involved in his care.
There does not appear to be any problems in his relationships with family/friends that might affect a future community placement.
HARD TO PLACE SCORE:
The hard to place score is an aggregate of scores of different factors that may make someone hard to place in a community setting. A score of 10 or above indicates that someone may have been considered hard to place.
X scored 10 in the following areas:
 MHA 1983 detention in hospital (5)
 Psychological impairments (2)
 Secure environment (3)
At the review October 2008, he scored 15 (additional five was in the area of dangerousness).
OVERALL LEVEL OF NEED/PLACEMENT:
Though X does not appear to have great insight into his illness or the need for medication and treatment, there has been a marked improvement in his mental state in relation to his ability to utilise support appropriately, adhere to restrictions and comply with recommended treatment plans.
X is currently allowed three hours unescorted leave daily in addition to weekend leave to his mother and this has been going very well.
I believe he no longer requires a low secure placement but given the ambiguity about his compliance with medication, I think he will continue to require to be treated under the
Mental Health Act 1983, hence the local rehabilitation ward may be appropriate.
CLIENT PREFERENCES:
X expressed a desire to return to his home borough. I informed him that given his improvement and pending further discussion we may be able to consider a rehabilitation ward, he was happy with this plan.
He was however unwilling to discuss future goals.
5

SUMMARY:
X is a 24 year old man with a diagnosis of Paranoid Schizophrenia.
He was first referred to psychiatric services by his GP in 2002 at the age of ------ and his first hospital admission was in 2004, presenting with paranoid and delusional ideas.
He was initially under the ------service but his engagement was poor hence the team had difficulty supporting him in the community.
Since 2006, he has spent long periods in hospital; this current admission started in July
2007 when he was admitted informally to …… (but was later detained under section 3
MHA 1983). While an inpatient on an acute admission ward, X absconded several times; on one occasion he took an overdose of 60 paracetemol tablets whilst AWOL. He was later transferred to ------ward but he was reported to be agitated and required sedation.
X was subsequently transferred to ------ward.
His forensic history started at the age of ------; some of his later offences appear to be linked with his psychotic symptoms. There is also past evidence of drug and alcohol misuse; not thought to be a current issue possibly due to his detention under the MHA.
However he is having daily unescorted leave but there has been no suspicion that he has used drugs or alcohol.
X started treatment with Olanzapine in September 2008.
Though he continues to hold delusional ideas, the risks appear to have reduced and he appears more able to utilise the support of staff members when he is distressed by symptoms. This however will continue to need monitoring.
One potential risk I believe requires further assessment is his expressed “sexual feelings” when in the company of some female staff members. I highlighted this and was informed that a male staff member has been assigned to explore.
X remains compliant though he has expressed his reluctance to take medication on several occasions. Initially he expressed that he is only taking medication because he has no choice. When I explored further in relation to being out of hospital, he indicated that he may take voluntarily if he was advised to do so.
His current leave status is three hours unescorted daily leave in addition to weekend leave to his mother. This has apparently been going very well over the last few months. X informed me that he uses his daily leave to go jogging; he either travels back to -----or jogs locally. His weekend leave however appears to be less active, he stated that he does little at his mother’s.
I believe X would now benefit from a rehabilitation placement rather than a low secure ward. Given the ambiguity about his compliance with medication, a hospital setting would possibly be the best option initially, in order to ensure that his medication treatment is not disrupted.
PLAN:
Refer to rehabilitation ward.
Signature
6