ABI Medium 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 Medium Secure Service

St Mary's provides medium secure assessment and treatment beds for patients with Acquired or degenerative Brain Injuries, detained under the Mental Health Act. Patients are admitted to Adam's ward following a detailed pre admission Multi Disciplinary assessment. Patients are usually referred from the courts, prisons, high secure hospitals, other secure and non-secure psychiatric hospitals.

Patients typically present with marked 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. Adams Ward caters for individuals representing higher levels of risk. This may be reflected in serious or frequent behavioural disturbances, a significant potential for aggression and interpersonal violence, unpredictability or subversive behaviours

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.

Within Medium Secure services, we are constantly developing a consistent Care Pathway that provides a structured process to ensure the delivery of high quality care and evidence-based practice throughout the Medium Secure service. Our aim is to promote optimisation of the patients' cognitive and functional abilities and reduce attendant risks so that the pathway from medium to low secure services is facilitated.

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 Medium Secure Service

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