Case Study: Supporting Recovery from Psychosis & Severe Self-Neglect at Baldock Manor Hospital
A real outcome service user case study
Service User Profile
Service User: ZB (anonymised)
Primary Diagnosis: Schizoaffective disorder
Service: Burberry Ward, Baldock Manor Hospital
Presenting Needs:
- Severe psychosis and delusional thinking
- Responding to unseen stimuli
- Significant self-neglect
- Poor personal hygiene
- Support with medication adherence
- Support to maintain appropriate nutrition
- Diabetes management and wider physical health needs
- Therapeutic and psychological support
- Care that recognised and respected ZB’s cultural and religious needs
This case study demonstrates how consistent, person-centred care addressing mental health, physical health and everyday wellbeing together supported ZB to move from a period of significant instability towards a much safer and more stable position.
ZB was admitted to Burberry Ward at Baldock Manor Hospital with a diagnosis of schizoaffective disorder and experiencing severe psychosis.
At the point of admission, ZB presented with delusional thinking and responses to unseen stimuli. Their mental health had deteriorated to a point where there was also a significant level of self-neglect.
Their needs extended beyond the management of psychotic symptoms.
Personal hygiene, nutrition, medication adherence and diabetes management all required support, meaning ZB’s mental and physical healthcare needed to be considered together rather than as separate issues.
The team’s priority was to help ZB move towards greater stability while addressing the everyday factors that had been affected by the deterioration in their mental health.
Looking Beyond the Diagnosis
ZB’s care was developed around them as a whole person.
Their individual care plan considered their mental health, physical health, personal care, nutrition, medication, therapeutic activities, relationships, culture and other individual needs and preferences.
This was particularly important because progress couldn’t be measured solely through a reduction in psychotic symptoms.
Improved personal hygiene, eating consistently, managing diabetes, taking prescribed medication and becoming better able to engage with daily routines were all meaningful indicators of ZB becoming more stable.
The team worked consistently across these different areas, providing support according to ZB’s presentation and needs as their recovery progressed.
Supporting Mental and Physical Health Together
Medication adherence was an important part of ZB’s treatment and recovery.
With support from the team, ZB became consistently compliant with their prescribed medication. Alongside therapeutic and psychological interventions, this contributed to the improvement seen in their mental state.
Physical wellbeing was addressed at the same time.
ZB required support around diabetes management, nutrition and personal hygiene, areas which had become particularly important because of the level of self-neglect present on admission.
As ZB became more stable, they began maintaining a healthy dietary intake and demonstrating consistent improvements in their personal hygiene.
The risks associated with severe self-neglect subsequently reduced considerably.
Respecting Culture, Faith and Identity
Another important element of ZB’s care was recognising that genuinely person-centred support extends beyond someone’s clinical needs.
ZB’s religious beliefs and cultural requirements were incorporated into their care, including consistently providing halal meals.
While seemingly a straightforward aspect of everyday care, respecting these needs helped create an environment in which ZB could feel understood and comfortable.
This approach was part of building trust and supporting engagement rather than expecting ZB to adapt to a standardised model of care.
For the team, respecting someone’s identity, culture, faith and personal preferences sits alongside meeting their mental and physical health needs. Each contributes to understanding and supporting the individual as a whole.
Outcomes Achieved
Over the course of ZB’s admission, substantial progress was made from their presentation on arrival. By the time of discharge:
- ZB’s mental state had stabilised significantly
- Psychotic symptoms had reduced
- The severe self-neglect evident on admission was no longer present
- ZB became consistently compliant with prescribed medication
- Personal hygiene improved and was maintained
- ZB maintained a healthy and consistent dietary intake
- The risks associated with self-neglect reduced considerably
- Diabetes and wider physical health needs were supported alongside mental healthcare
- ZB became better able to participate in everyday routines
- They engaged more appropriately with their environment and accepted support
- Their cultural and religious needs were consistently recognised and respected
Taken together, these changes represented a significant movement from the level of crisis and instability seen on admission towards greater safety, stability and day-to-day functioning.
What Made the Difference?
Consistency of Care
ZB’s progress wasn’t the result of addressing one isolated issue. Consistent support across medication, personal care, nutrition, physical health and psychological wellbeing allowed different aspects of their recovery to progress together.
Individualised Care Planning
ZB’s care plan reflected their particular presentation and needs rather than relying solely on their diagnosis of schizoaffective disorder. Mental health, physical health, medication, nutrition, personal care and therapeutic support were considered alongside their individual preferences, identity and longer-term recovery needs. This provided the team with a structured approach while keeping ZB, rather than their diagnosis, at the centre of care.
Addressing Physical and Mental Health Together
The level of self-neglect present on admission meant ZB’s physical wellbeing couldn’t be separated from their mental health. Support with diabetes management, nutrition and personal hygiene therefore formed an important part of the overall intervention.
As their mental state stabilised, improvements could also be seen in these practical areas of everyday life.
Therapeutic and Psychological Support
Therapeutic and psychological interventions formed part of ZB’s wider care, alongside medication and day-to-day ward support. Together, these provided a more holistic approach to recovery rather than relying on medication in isolation.
Respecting Culture and Faith
Providing halal meals and recognising ZB’s religious beliefs and cultural needs helped ensure their care remained personal to them. Respecting identity and individual preferences can help build trust and engagement, while ensuring that someone feels valued and understood during their time in hospital.
Conclusion
When ZB arrived at Baldock Manor Hospital, they were experiencing severe psychosis, delusional thinking and significant self-neglect.
Their needs were complex and interconnected. Stabilising their mental health was essential, but meaningful recovery also required attention to medication adherence, diabetes, nutrition, personal hygiene, therapeutic needs and the everyday routines that had been affected by their deterioration.
Through consistent and individualised care, ZB made substantial progress.
Their mental state stabilised, psychotic symptoms reduced and they became consistently compliant with medication. Their personal hygiene and dietary intake improved, they became more able to participate in daily routines and the risks associated with severe self-neglect reduced considerably.
Importantly, this was achieved through an approach that also recognised who ZB was as an individual. Their culture, faith and personal preferences formed part of their care, including ensuring their dietary requirements were respected throughout their admission.
By the point of discharge, ZB was leaving Burberry Ward in a safer, more stable and better-functioning position than when they arrived.
Their progress demonstrates the importance of treating the whole person rather than an individual diagnosis: bringing together mental healthcare, physical healthcare, therapeutic intervention and the everyday support required to rebuild stability and wellbeing.
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