Page 7 - TSAB Adult B FINAL (1)
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       5.13.  Josh was again assessed by liaison psychiatry on the Monday and was deemed to not have a mental
             health illness, albeit that significant social stressors were identified. Josh’s mental capacity was deemed
             to be intact although not formally assessed. As Josh continued to say that he did not want to go on
             living, he was seen as high risk of death, he was offered and accepted an admission to an inpatient
             mental health bed in order to further assess his mental state and to aid management of current risk.

       5.14.  During this admission which lasted just under 4 weeks, Josh was subject to ongoing assessment from
             the mental health team that included risk assessments and support from the mental health unit social
             worker. It was noted that Josh remained open to substance misuse services in Area A. The review
             learned that a request to transfer to substance misuse services in Area B had been made and the
             transfer had commenced. Josh did not attend or engage and therefore the transfer was never
             completed.

       5.15.  Discharge planning meetings were taking place that included the Mental Health Trust affective
                          2
             disorders team  who would support Josh on discharge. They were also attended by the ward team. The
             Hospital Inpatient Liaison Team from substance misuse services were invited but did not attend.
             Contact was made by the mental health team with Area B community substance misuse services the
             next day. The community substance misuse service planned to see Josh for assessment two weeks later.

       5.16.  Substance misuse services in Area A had closed their services to Josh as the transfer had been made to
             Area B. Area B substance misuse services could not prescribe for Josh until they had completed his
             assessment

       5.17.  Josh’s assessments on the mental health ward indicated a decreased risk and more motivation to
             change his circumstances with support of the team social worker. His mood was still low; medication
             was being monitored by the psychiatry team.

       5.18.  Josh had spent time off the ward during his admission with no apparent concerns.

       5.19.  Sometime following the discharge meeting Josh attended the ward clinic for his insulin to be drawn up
             for him to self-administer. Josh quickly altered the dial on the injection pen to give more insulin. The
             amount given is not known. He stated that he had done it because he had had enough. He refused to
             have his blood sugar recorded and left the ward. This was a marked change to his behaviour earlier that
             day.

       5.20.  A friend of Josh called the Police as he had made contact with her saying that he had taken an
             overdose. Police located him in the area that the friend had stated, and he walked back to the mental
             health unit with the police officers after refusing to ride in the police vehicle. Josh remained angry and
             upset about his impending discharge when he returned to the ward. Josh again left the ward with his
             friend to go for a walk.  She reported that he was argumentative and on a later occasion that he was
             following her, and she had phoned the police.  Josh was eventually returned to the ward accompanied



           2  The affective disorders team provides a range of support and treatment options for adult clients with any form of affective disorders. Affective
           disorder is a general term used to describe a range of difficulties relating to the way an individual feels, thinks and behaves. The service offers a
           full range of psychological therapies and medication.

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