Case Study on Robert

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Robert leaving school at 16 years with no qualifications, and inability to hold down a regular job is a concern. GovUk (2022) highlights that 57% of adults entering prison have literacy levels of 11 year olds, linking a lack of education and violent crime (Groot & Van Den Brink, 2010); however more research is required to fully support the link. The case study highlights social, biological and environmental factors such as Robert witnessing his father being verbally and physically abusive. Understanding and recognising traumatic events and building knowledge of their effect on development, going into adulthood is vital. Trauma events occur when yourself or someone is at risk of harm making the individual feel unsafe (MHF, 2022), Robert shows signs through his presentation of anger, social isolation, concentration levels and low mood (NHS, 2022). When Children are exposed to toxic stress situations; such as physical abuse, emotional abuse, neglect and death (NSPCC, 2021); the brain chemical balance changes affecting development and responsiveness to situations such as stress management, lifestyle choices, physiological issues and mental health (MH) concerns (Franke, 2014).

After Robert’s incarcerated he’s placed into segregation due to “challenging behaviours” which fluctuate. The Guardian (2015) reported 23% of male prisoners were “assessed as suffering from anxiety and depression”, this could be due to being deprived of social interaction, routine, fresh air, panic attacks, anger, hallucinations, impulse control, withdrawal, and increased chances of self-harm (Medical News Today, 2022). Another area of concern for Robert following his admission to a Medium secure unit (MSU) was his aggression, challenging behaviour, lack of willingness to engage in therapy and refusal to get out of bed. According to the NHS (2022) Robert is showing symptoms of ‘Clinical depression’ through anxiety, suicidal thoughts, irritability, low self-esteem, and lack of energy.

Another area of concern was the secretion of medication resulting in mood and withdrawal issues, creating a potential lack of trust with professionals, lack of understanding of medication, insight and collaborative involvement, (Mitchell & Selmes, 2007). Another issue is Robert’s highly inappropriate sexualised and offensive comments towards co-workers, and issues regarding his temper and lack of insight to consequences. This is a sign that Roberts diagnosis of ‘Emotionally Unstable Personality disorder’ (ICD11 6D10) isn’t under control and is affecting himself and others, manifesting in symptoms of insecurities, difficulties in maintaining/creating relationships, volatile changes to emotions and dissociation (Mind, 2022). Robert has been admitted to MSU for 3 years and is held on section 47/49 under the Mental Health Act 2008 (MHA). It’s reported 27% of inpatients stay at least 10 years in secure settings (Holley, Weaver & Vollm, 2020) and long-term stays can offer individuals stability and access to resources contributing to recovery (Cherry, 2022); however unsafe environments, vulnerability, overcapacity and lack of resources can affect well-being and recovery; emphasising appropriateness of care (Weber, et al, 2021)

The Bradley Report (2009) highlights issues surrounding individuals entering the criminal justice system struggling with their MH and/or learning disabilities (LD). The Bradley Report (2009) was a catalyst for improving services and providing specialist care to improve wellbeing, provide appropriate care to reduce reoffending rates, and provide adequate training/education for staff to be effective. The Prison reform trust (2022) states 52% of prisoners reported having MH issues (between 01/07/2020-31/03/2021) and approximately 29% whom participated in education had an LD in 2019/2020.

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