Elisa* is a lively, intelligent lady with a profound learning disability who enjoys the great outdoors, swimming, shopping, looking at books and flicking through photographs. She doesn’t use verbal communication and gets frustrated when misunderstood.

Elisa lived with her family until her parents were no longer able to provide for her needs, at which point she was initially moved to a psychiatric unit before going through a variety of placements. This was an extremely difficult time for Elisa and she expressed her frustrations by exhibiting intensely challenging behaviour, which resulted in frequent sedation.

In 2001, Elisa was transferred to United Response and supported by a team leader, five permanent staff and a small bank of relief workers. Over time, the team built up a strong relationship with Elisa and her parents.

Through conversations and using person-centred support, Elisa’s support team pinpointed their concerns: that the mood stabilisers were making Elisa more unpredictable and the strong medication was masking her personality.

The results of her medication reduction

This prompted them to meet Elisa’s psychiatrist, who drew up a three-year medication reduction plan for her. Although Elisa was not able to express her views about this, staff explained the changes to her and kept her informed every step of the way.

The withdrawal stages were difficult as Elisa’s challenging behaviour became more pronounced and she would behave aggressively, pinch, scratch, grab clothes and drag staff to the floor. Each stage took varying lengths of time from a few weeks up to a couple of months.

The effects of the medication reduction plan – alongside the effective implementation of person-centred techniques and guidance from a speech and language therapist – have cumulated in improving Elisa’s life beyond recognition.

With hindsight, staff can see that when Elisa was on medication, she was constantly anxious and agitated.

One staff member explains: “We assumed that the medication was supposed to help; we didn’t realise it could be making things worse.”

This is echoed by Elisa’s mother: “She’s a different person now. We’ve got the old Elisa back.”

Positive behaviour support

Staff can now defuse potential episodes before they begin, without resorting to sedatives, by using a range of distraction techniques that involve engaging Elisa in other activities. These days, Elisa goes out about twice a day and staff are currently working on an activity planner to ensure she is participating in meaningful activities they know she enjoys.

Elisa is now calm and relaxed. She will sit down and interact with staff, read a book or look through family photos. She even settles down for the evening to watch TV with staff – something she has never done before.

Looking back at the progress made over the past 13 years, her team leader reflects: “Our work really can change lives."

*Name has been changed.

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