Page 8 - TSAB Adult B FINAL (1)
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             by the Crisis Suite staff as he had presented himself there.   Josh refused to engage and went to bed.

       5.21.  Josh refused to attend the housing provision that had been arranged by the mental health team social
             worker on the day of discharge. He was later discharged with a plan that consisted of:

                      Appointment for assessment with substance misuse services in Area B to start his support
                        and prescription with local services
                      Present at homeless service as he had refused the arranged accommodation
                      Register with a specified GP practice who would provide his prescription for methadone
                        and other medication
                      For follow up with the affective disorders team once he had an address

             Key Phase Two- Day 36- Day 62

       5.22.  When Josh was discharged from the mental health unit, he walked across the hospital site to the acute
             hospital and presented at the diabetic clinic stating he had taken an overdose of his insulin stating that
             he wanted to end his life.

       5.23.  Josh was admitted to hospital and treated for his overdose. He was assessed again by liaison psychiatry
             the following day as he was medically fit for discharge. Josh then took further overdoses of his insulin.
             Liaison psychiatry found him to be distressed at his circumstances and fearful of going back to living in
             the community. Although he was reactive and tearful, he showed no signs of obvious depression or
             psychosis.

       5.24.  Josh remained an inpatient. His GP was contacted to see if they would be able to prescribe his insulin
             daily and observe him administer it in an attempt to prevent further overdoses. The GP practice stated
             that, whilst they were able to offer daily prescriptions, they could not supervise administration due to
             resourcing issues. Josh was offered the use of the clinic to receive his daily insulin, but he declined
             stating that he would continue to take overdoses.

       5.25.  During this admission, a safeguarding referral was made to the Local Authority. This resulted in initial
             enquiries by the Adult Safeguarding Team in the Local Authority requesting information from the
             hospital social worker who went to see Josh. The social worker had made contact with homeless
             services so was appraised of the circumstances regarding accommodation provision for Josh. When the
             hospital social worker visited, Josh refused to engage in any assessment and left the ward. Staff on the
             ward were told by the social worker that if Josh would not engage in an assessment then he could not
             be helped. No further face to face contact was attempted.

       5.26.  Josh was also assessed by the substance misuse services Hospital Inpatient Liaison Team, Josh stated
             that he wanted to re-engage with a methadone programme and consented to community support. Josh
             was discharged in a taxi to the homeless service in Area B and was also to present himself at the GP
             practice who had agreed to prescribe his methadone.





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