Case Studies
Subtle Brain Injury
Pete was referred to Community Case Management Services Ltd (CCMS) for assistance to find alternative employment due to impending redundancy prior to closure.
He was independent in activities of daily living. However following a meeting and assessment which entailed taking a careful history, it became apparent that his current lifestyle was completely different to that of his pre-index event.
Prior to the index event he had been happily married, owned a home of his own, enjoyed frequent holidays away, and often went on walking and camping weekends. He was an active, athletic man, keen to keep fit. He enjoyed socialising and “a jar” two-to-three times a week. Although he was not an outgoing man, he was described by his long-term friend as a relatively happy and contented man. However, all that changed. He lost interest in his wife, had lost his libido and did not want to continue with the couples previous hobbies and interests. Eventually his wife filed for divorce.
Following this Pete showed no interest in where he would live, or in any financial settlement. With prompting from his now only friend, he asked for money for a motorbike, a former interest. His wife took all the proceeds from the sale of the matrimonial home.
What he did have was a highly-structured job in which he received a great deal of support from a sympathetic manager. His job was described by him and his friend as his world, coupled with what had now become a rigid compulsion to follow a workout programme at the firm’s gym. What was previously an interest had now become obsessive.
His only friend was concerned and offered him a room to rent. Whilst he had use of the rest of the house he did not use it. He would sleep for a short while there, leaving between 5.00 am and 6.00 am each morning to attend the gym, then to attend his job, which was very undemanding and now consisted of setting up rooms in readiness for meetings. This in fact was only a small part of what he had been responsible for previously.
He would eat in the subsidised canteen, finish work, and return to the gym. He would then go to his mother’s for a sandwich at which time he would hardly speak to her, returning to his rented room for 9pm. The routine would then be repeated the following day. Weekends saw an increase in attendance at the gym which was available to him, a sandwich as his mothers home as his only meal and the highlight would be an outing on his motor bike.
It was quickly identified that Pete was living in a comfort zone. He had no responsibility for managing money, as his rent was paid each month by standing order organised by his friend and was an “all-in cost”. He did not plan or prepare any meals for himself. He had no social life and little interest, except for his motor bike, which did not involve any contact with others. He had been struggling with his energy levels, initially presumed by his mother and friend to be due to his gym work and relatively low intake.
The case manager was concerned and arrangements were made for him to be accompanied, or he would not have gone, to his GP for blood tests. The results showed low testosterone. This prompted referral to an endocrinologist, treatment and management followed with obvious improvement.
The case manager encouraged Pete to question why he continued to live in a room, which he did not regard as his home and where he did not feel comfortable. Eventually he engaged in a search for a single-bedroom flatlet that he could afford within an area that was considered reasonably safe. Whilst Pete had agreed to the search for a property he did not consider it necessary for it to be furnished, suggesting he slept in his sleeping bag and use a camping stove, left over from his camping days. His mother took a hand in sourcing a bed and linen and he was accompanied to charity shops to find cutlery, saucepans, and other needed household utensils.
Pete settled into his new accommodation over a three month period. Initially he was very anxious and there were frequent telephone calls to the case manager for reassurance particularly in regard to managing his finances, deciding who to invite each month for a meal although there were few choices, and what meals he should prepare. Beans on toast was a favourite to begin with but things improved until he could manage spaghetti bolognaise using a jar of sauce.
Some goals were set in regard to meal planning and preparing same. This required a great deal of prompting and encouragement, but the aim was for him to plan for and cook three meals a week and once a month to invite a guest. He achieved this eventually.
Pete would visit a local laundrette and have his clothes laundered and pressed for him weekly. This arrangement suited him and his family well and it was continued.
The case manager had challenged his mental health/capacity at the time of the settlement of financial matters following his divorce. This was investigated.
Pete became more confident in his own flatlet and started to personalise it. He grew in confidence and developed a relationship with a neighbour, resulting in a weekly meeting at a local pub, although he kept rigidly to one pint.
The expected closure of the firm did not actually take place and Pete was able to continue with the company in a similar role following it being taken over by new owners. The gym work outs continue daily but not twice a day as he likes to return home to cook his supper in his own home.
Case management continues as required at a level of circa 18 - 24 hours a year. This maintains Pete living in his own home and provides support during the usual life crisis, which cause him to falter.