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ABI Low Secure Service

St Mary's Hospital provides specialist neurorehabilitation for men with acquired or degenerative brain injuries who due to their behaviour have a forensic history or complex and challenging needs.

ABI Service Ethos

We offer individualised neurorehabilitation programmes within a multi disciplinary team framework in medium and low secure conditions, combining positive behavioural support as part of the My Shared Pathway approach. Patients are cared for in different wards based on the level of security required, their level of cognitive functioning, physical healthcare needs and peer group.

Details of the ABI Low Secure Service

St Mary's provides low secure assessment, treatment and rehabilitation beds for patients with an Acquired or degenerative Brain Injury detained under the Mental Health Act. There are two wards within the Low Secure Service namely Dalston ward and Burlington Complex care ward. Advanced rehabilitation suites are also available which promote semi independent living prior to discharge.

Patients are admitted to the low secure service following a detailed pre admission Multi Disciplinary assessment. Patients are referred from the courts, prisons, non secure hospitals and community placements, and medium secure unit's (M.S.U) including St Mary's Hospital as part of the Care Pathway to a less restrictive environment.

All patients have an initial 12 week multidisciplinary assessment of their cognitive, psychological, mental health, occupational, social and physical health needs in formulating care plans to promote treatment and rehabilitation. A comprehensive risk assessment is also completed. . An enhanced Care Programme Approach (CPA) meeting is held following the initial assessment followed by regular 6 monthly CPA meetings where the patients' progress is discussed and future carepathway agreed.

Dalston Ward

Dalston Ward caters for patients who are physically more capable and in general more able with regards to self care. Cognitively, patients on Dalston Ward are on average comparatively better functioning, but typically present with significant dysexecutive features, with impaired functioning in domains such as impulse control, planning, foresight, empathy, emotional regulation, behavioural self-monitoring, problem solving, mental flexibility, self awareness and social interaction. Risk behaviours are not as serious or frequent as in medium secure but require careful risk assessment and management.

Rehabilitation suites are available pre-discharge within the Low Secure Service (attached to Dalston Ward) to facilitate greater independence, dependant on the progress made by each patient on the LSU. The focus here is on promoting independent living skills (cooking, shopping, budgeting etc) with greater community exposure (typically being unescorted) to prepare them for discharge from hospital to live relatively independently in supported community placements. Patients are encouraged to consider undertaking community based activities including attending college and carrying out voluntary work, when and where appropriate.

Therapeutically, the emphasis on Dalston Ward is more on establishing a predictable, meaningful structured routine by means of a pre-planned diary in order to maximise the patients' independence. On Burlington Ward, the approach is more flexible, and activities and possibly even visits can be facilitated at much shorter notice or spontaneously, to accommodate a temporary improvement or deterioration of the patient on the day.

Therapeutic interventions

All patients across the medium and low secure service are managed within a Neurorehabilitation framework with a balance between restorative (remedial) and compensatory (adaptive) approaches. Our treatment and rehabilitation program includes:

  1. Providing a safe, secure and structured environment with intensive support with self care and day-to-day activities as required whilst encouraging independence.
  2. Preventing self-harm and containing aggression. Providing crisis support if and when necessary.
  3. Tolerance-adapted levels of stimulation (avoiding under or overstimulation)
  4. Monitoring mental state, behaviour and interaction.
  5. Monitoring physical health and liaison with other medical agencies to arrange investigations and treatment as necessary.
  6. Provision of external compensatory systems (e.g. diaries, planners, etc.), regular orientation, providing a structured daytime routine, antecedent control, managing communication and providing information commensurate to the patient's level of cognitive functioning. Compensatory systems ensure patients are prepared for the day ahead of them, which alleviates many difficulties this patient group has with planning, organising and sequencing activities. Restorative approaches including cognitive retraining is promoted to improve impaired functions where appropriate.
  7. Encouraging participation in social, recreational, diversional, vocational and occupational therapy activities and helping establish a meaningful daytime routine.
  8. Informal social skills training and improvement of behavioural self-control via re-direction (reflection on maladaptive behaviours and the adaptation of more appropriate behavioural strategies).
  9. Prevention of access to potential destabilisers such as drugs or alcohol.
  10. Controlled administration of psychotropic medication and monitoring for side-effects.
  11. Graded, safe community exposure via escorted, shadowed unescorted or unescorted planned leave to suitable destinations dependant on patients' cognitive and functional abilities (including community skills such as road awareness) and progress along the carepathway.
  12. Speech and Language therapy; and Physiotherapy if and when required.
  13. Provision of specific psychological and occupational therapies tailored to meet the needs of patients with cognitive deficits.

Specific psychological and occupational therapies

The specific psychological and occupational therapies provided includes:

  • The My Shared Pathway group
  • The Nice and Safe Attitudes group (NaSA), which promotes emotional self-regulation
  • Substance Misuse treatment
  • Brain Injury Awareness group
  • Social skills training
  • Relaxation training
  • Breakfast and lunch groups
  • Creative Writing Group
  • Art Group
  • Horticultural Opportunities
  • Musical Appreciation Group
  • Fishing group
  • Walking group
  • Woodwork group

All of the above can be facilitated in group or 1:1 sessions dependent on need. Increased access to the community allows for patients to progress by attending college and carrying out voluntary work, when and where appropriate.

Location of the ABI Low Secure Service

This service is located at St Mary's Hospital in Warrington.