Mental Health Services Care Proposal Plan Package set-up (Adult)

Robert’s* background

22-year-old Robert has a 10-year history of mental health difficulties which has resulted in frequent self-harm and suicide attempts. He was diagnosed with Emotionally Unstable Personality Disorder (EUPD), Depression, Somatoform Disorder and Dysphoria.

In November 2019, Robert took an overdose and was rushed to A&E and has since remained in hospital as an informal patient. After treatment and close monitoring, Robert is now ready to transition from an acute setting back into the community.

Establishing potential risk behaviours

Thorough risk assessments were carried out to gain an accurate and detailed understanding of Robert’s potential risk behaviours. The following were identified:

  • Deliberate self-harm through overdosing and/or using other objects
  • Impulsive behaviours and unable to regulate and manage emotions
  • Multiple physical health concerns, including Postural Orthostatic Tachycardia Syndrome (POTS)
  • Requires PEG feeding and help with self-care due to low mood
  • Faecal leakage which requires assistance when mood is low to help manage the area
  • High suicidal risk in a community setting

Recovery-focused care plan

Robert requires a recovery-focused care plan, tailored to his individual needs. The plan will focus on the following interventions and treatment strategies:

  • 2:1 support of which one member of the care team should always ensure Robert is within eyesight, due to risk of self-harming
  • The NHS mental health community team will facilitate psychology sessions for Robert around managing and expressing his emotions
  • Pharmacological treatment for his depression in the form of anti-depressants
  • Physical health medication for managing pain

Support worker-led care team

The package of care will be led by a highly-skilled team of support workers. They will have specific experience working with individuals who have been diagnosed with a personality disorder and will have the ability to problem-solve and de-escalate crisis should they arise. This includes acts of restraining should verbal de-escalation techniques fail. Our support workers will undertake mandatory training, including safeguarding, medication management and basic life support. In addition, they will be trained in the areas of personality disorder, PEG feeding and physical interventions.

Person-centred approach

Our service follows the personality disorder guidelines set out by the National Institute of Health and Care Excellence (NICE). These will be tailored to Robert’s specific needs, as outlined below:

  • Prior to the assessment, we gave Robert the choice of male or female support workers
  • Upon assessment, Robert was able to freely express his feelings and understanding of his emotions and self-harming in his own words
  • When care commences, Robert will be treated with the same respect and privacy as any other client under our care
  • Our support workers will be fully trained and prepared for the likely distress associated with self-harm. They will have regular clinical supervision and be fully supported by their regional clinical lead (RCL)
  • Robert will be involved in every aspect of decision-making and he will be given the autonomy to make decisions around the care he receives.
  • Our team of support workers will establish therapeutic, interpersonal relationships with Robert and open and honest communication will be established from the outset.



Get in touch

For more information about our Mental Health Service and how we can support you, please get in touch:

0333 323 1266

*Name has been changed for data protection