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Case Studies

Case studies can be a useful tool when trying to provide evidence of outcomes that cannot be captured by hard data alone.  They can provide context to an individual case and illustrate the human aspect of any given individual journey. 

Below are some case studies of Bridge members.  Some are written by Bridge staff and some by the member themselves.

“He used to carry matches around with him everywhere he went in order to burn his arms and hands…”

This member has been struggling with his mental health for around 20 years and was admitted to Berrywood on 26/12/19 following a suicide attempt. He has used Bridge for a number of years but didn’t engage with any of the activities other than meditation. He would often drop in and sit in the café without engaging with other members.

After being discharged from Berrywood, I encouraged him to try some other activities and he attended men’s group a few times prior to the pandemic which he enjoyed. I have also been working with him throughout the pandemic by ringing him regularly and meeting him for walks. He has struggled with his mental health and is still experiencing suicidal ideation but has not acted on these thoughts. Instead, he has reached out for help from either myself, the mental health hub or the crisis café when he feels that he may act on these thoughts. In addition to this, he reports that he hasn’t self-harmed for 18 months now. He used to carry matches around with him everywhere he went in order to burn his arms and hands but no longer does this.

While Bridge was able to open last year, this member took every opportunity to attend groups and tried activities that he would have previously said no to such as the photography walks and desert island discs. He thoroughly enjoyed them and the routine had a huge impact on his wellbeing. He has previously told me that this along with our regular contact has saved his life.

Recently, Bridge agreed to loan him a tablet alongside ETE sessions as he is computer illiterate and doesn’t know how to use a mobile phone. He has been using these sessions to attend our online relapse prevention group. He has been making good progress with being able to use the tablet and when he is able to use it on his own, we will look to support him with getting some internet at home.

 

He also engages regularly with a local depression support group and now receives calls from Happy at Home weekly having been referred by the mental health hub. 

“I was afraid to answer the phone due to how it affected me mentally. I was no longer seeing my child because of what I had been doing, and he is my life.”

I was a user of NPS’s, particularly Spice – Pandora’s box and Exodus. I used with people I worked with at weekends but eventually I used every day. This lasted 18 months. I lost everything – my partner and child, my home, and my job. I suffered with hallucinations, psychotic thoughts, weight loss. I was afraid to answer the phone due to how it affected me mentally. I was no longer seeing my child because of what I had been doing, and he is my life. I made a decision to stop and was able to do this by shutting myself away for 4 days.

I was homeless and had to rely on the friends and family that had remained in my life for somewhere to stay. I was isolated and needed to meet people. I attempted to go to Bridge three times. On the first two occasions I struggled and could not do it. On the third I built up enough courage to do so. I’m glad I did.

I sought help with my housing situation by visiting the housing drop in. Julia helped me with this and made a referral to PHaSE Housing, supported housing for people with substance misuse issues, provided by Bridge. I was interviewed for this and was successful with my application. A month after my induction I was now housed through PHaSE and supported to manage my tenancy, provided help to set up my utilities, bills etc.

Most importantly I now had somewhere for my son to visit and to stay.

I had been keeping myself busy at Bridge, trying new activities, meeting new people. They were not as scary as I thought they would be, and it was comforting to be around people who had similar experiences with addiction that I did, and were trying to get themselves clean/sober. It was good to speak with people and to talk freely without feeling judged. I particularly enjoyed using the gym, football and acupuncture (something I did not think I would!)

I applied to become a volunteer at Bridge. Initially just a couple of hours a week, eventually leading to full – time. I like to help others and felt like I wanted to give back to Bridge for all the help I have received from them. I attended the mentoring course held at Bridge, which I enjoyed. I would speak with members, particularly those just starting at Bridge, as I remember how difficult it can be to start this journey. I volunteered at the ETE sessions (Education, Training and Employment) and enjoyed helping people looking into courses, searching for employment etc. Through this I was able to refer a number of members to a service who provide courses to people, which made me feel good. A role within their company came available recently, which I applied for and was successful for, starting a full- time job.

7 months after my induction, I am still clean.

I have a fantastic relationship with my son and see him regularly.

I have a home.

I have full- time employment.

I have built good, supportive relationships, and those with family members have improved as they have seen my progress.

I have responsibilities.

I feel trusted.

I am contributing to society.

I feel like a better person.

There is hope for people like me.

“Due to Nick’s mental health difficulties, he would often cry during our calls and make reference to suicide because he was unhappy with his life.”

How did they first present?
The first call I made to Nick was on the 18th of March 2020, where he first presented as reluctant to talk to anybody. He told me he lived alone with his cat and goes long periods of time not seeing anybody and therefore often expressed that he felt lonely. He does not have much family close by or any friends and It became clear after a few phone calls that he was heavily drinking, although at the time he would deny this. Due to this member’s drinking, he has atrophy to the brain resulting in irreversible, severe memory difficulties often leaving him confused as to what he is doing and unsure of who he is talking to on the phone mid-conversation, made worse when drinking. At one point, Nick attempted to read out his bank card details to me due to forgetting what we were speaking about. I stopped Nick from doing this, but this is just one example of how bad this member struggled.

Not only does Nick have a poor memory but he lacks in mobility due to damage done to his knee quite some time ago, the pain has escalated over time and causes him great difficulty, so he is prescribed painkillers from his GP because of it. Alongside the confusion, physical disability and the loneliness, Nick also experiences agoraphobia, depression, and general anxiety, often making it difficult for him to leave the house and feeling on the verge of a panic attack. Nick only leaves the house once a week on a Monday to go to a Tesco Express to do his weekly shop, something that has happened for the entire duration of our calls together. Due to Nick’s mental health difficulties, he would often cry during our calls and make reference to suicide because he was unhappy with his life. It was apparent that this member had been neglecting himself as he would tell me he had not eaten for several days because he did not have any food, or that he has not had a bath/shower for ten years (when he first moved into his flat) because he cannot access hot water without boiling the kettle.

What support did they require?
After speaking with Nick for the first time, it was clear to me that he did not have capacity and was very much in need of support. He seemed to need support in terms of his mental health, mobility, needing food, his living situation as he struggles walking up and down the stairs to get to/leave his flat, hygiene and general support in every-day tasks as well as the fact he was in denial about his drinking problem.

What support did you provide?
To support Nick, I have made many phone calls to his GP on his behalf to get him medication reviews, doctors’ appointments and even to get advice on how I can better support Nick with his memory difficulties. I have expressed my concern relating to his mental health, self-neglect and his mobility problems, the core things they can potentially help Nick with.

Following on from the call, I made a referral to social services for Nick due to my concerns of him struggling in all aspects and in my view, because he needed additional support. Unfortunately, the first referral was closed almost immediately by social services due to them feeling they could not help Nick’s situation. Not long after this I was contacted by a police officer (Nick gave him my number), who expressed concerns for Nick’s safety due to him calling the police in the early hours of the morning for somebody to talk to. The police officer attended Nick’s address and saw clear signs of self-neglect, mentioning that the house was smelly, dirty, unhygienic, and stated he did not have any food in the house or even a working fridge. From this point, I referred Nick to social services again, alongside the police officer making a PPM referral.

During periods where Nick had not eaten because of not having any food in his house, I made multiple referrals to the Daylight Centre to help him alongside providing him details to The Mental Health Hub and the Community Resilience Hub, which he utilised on at least one occasion in what felt like a time of crisis to him. I often help Nick write lists and ask him to put them in obvious places to remind him of important appointments/events, so he does not have to rely on his memory which seems to really help him. Examples of this is when waiting for a call from his GP, I will help him write a list of his health problems he has told me about that he would like to discuss so he does not forget anything, as well as when receiving a visit from social services, a list of things he would like support with. Not only this but there was a period where Nick could never remember if he had taken his medication or not, so I encouraged him to write a medication diary including the date/time he had taken it so he could check.

Other support included offering guidance on how to shop at low cost, to ensure he has enough food for the week and providing him with taxi company phone numbers to get him to a blood test recently following a doctor’s appointment he had, which I arranged for him due to him having pain in his back, numbness in his feet and dizziness when standing. Nick felt he could not make this appointment himself because he was scared there was something seriously wrong with him, so I did this for him with consent.

What was the achievement?
The support provided to Nick yielded many positive results and changes. Since speaking to Nick’s GP, I was able to gather enough information which allowed me to understand how best to support Nick which resulted in referrals being made. The second referral to social services has proven to be effective, as well as writing a list of needs to present to his social worker on his first visit because this resulted in Nick receiving regular home visits from social services, phone calls and additional support from them. This includes having somebody else to talk to (they referred him to Glamis Hall, so he occasionally receives a call from them, this helps with the loneliness). Social services are going to create a plan with Nick to move him into more accessible accommodation (a ground floor flat) given his mobility issues which will also solve the problem of not having any hot water. This is going to be greatly beneficial for Nick, because it prevents him from experiencing additional pain walking up and down the stairs and it will allow him to have better hygiene and live more comfortably, these plans are currently being put in place.

Due to arranging doctors’ appointments and medication reviews for Nick, he is now being given the right medication to address his mental health needs and the pain he suffers with his bad back and knee injury, which has resulted in a positive mood change. They have added an additional medication for his anxiety and to help with his sleeping. Nick now presents as being happy most of the time and no longer makes reference to self-harm or suicide which is the complete opposite to how he was when we first started speaking. He no longer tends to cry in our phone calls together which used to occur every time we spoke. Nick also now has regular contact with a mental health nurse which he finds helpful. Since his mental health has improved, Nick has been able to go out and do his weekly shop feeling much safer, whereas before, his agoraphobia would make him feel as if he were going to have a panic attack because he felt anxious and unsafe. Not only this but when we speak now, Nick often presents as being sober and coherent, it is only occasionally where he is not, whereas in the beginning, every time I spoke to him, he would be intoxicated, and this would be across various days of the week. Nick recently admitted to sometimes drinking on a Monday but then not for the rest of the week.

Since Nick attended his blood test regarding his health difficulties, he has presented as less worried as he now knows he does not have something seriously wrong with him like he thought he did, which he said used to be always on his mind. Since the support Nick has received by multiple services, he has made many positive, recognisable changes as a person which has resulted in him drinking less and often not at all, allowing him to be more coherent and less confused.

The food parcels received have enabled Nick to eat proper food, whereas before if all he had was severely mouldy bread, he would eat that to get by/because he was so hungry.

How did they feel about this? And the support provided?
Nick has always been incredibly grateful about the support he has received from Bridge and other services, Bridge seems to be the first service he turns to if he is having a bad day and needs support because he knows he will receive it, whether it is just somebody to talk to cure his loneliness or making a referral to another service for additional support. This is shown by the fact that when the police officer attended his address, the first contact number he thought of was a Bridge contact number, or when he has injured himself, he will think to contact Bridge before a doctor. Nick could not even remember my name to begin with but now Bridge is a service he relies on.

Comments:
Some comments Nick has made throughout our time working together over the last 12 months which I have recorded in my case notes are:

“Talking to you has cheered me up”.

 “Speaking to you has changed my whole mood”.

 “You’re doing wonders for me” – When speaking about a time he would only drink on a Monday.

 “You have been so kind to me; I’m actually choking up at how kind you’ve been to me”.

 “Thank you for everything Jess, I appreciate everything you do for me”.

 “As long as you’re at the end of the phone, I don’t feel so alone”.

 “I appreciate all your help at the moment”.

 “You’ve got to take 70% of the credit for how I am” – Comment mentioned when reflecting on the progress he has made.

 “I do really appreciate your input into my life, seriously you’re doing a very good job”.

 “You are my lifeline”.

 “You may not know it, but you are really helping me”.

Nick referred to us all at Bridge as being “unsung heroes” and said, “I can’t praise you all enough”.

What position are they in now?
As a result of all the support received, Nick has previously reported to have cut down his drinking, is eating better (through periods of depression he had a loss of appetite) and is sleeping better.

From a phone call I had with Nick today, where I got consent from him to use his name and consent to present his case, when receiving support, he said “it’s nice to hear from a friendly voice, I appreciate it”. When discussing how he was when we first started working together, he said “I was in quite a dark place then, I do feel more positive now and I’m not drinking” which he agreed is helping his mindset and helps him feel less confused.

Nick mentioned he has received general support from me, help with food parcels and has found “just knowing that you’re there” helpful.

“A circular route will always lead you back to the place where you started.”

MAPS AND COMPASSES
Recovery, more often than not, is a long and difficult journey. The most intrepid traveller might be tempted to go it alone but it’s better to have an experienced guide or, at the very least, a good map and a decent compass.

He looked me squarely in the eyes and asked me why. It was a simple question, but the answer was complex. I wasn’t feeling very well that day and the complexity frightened me. So I shrugged and examined my fingernails. But he wouldn’t let the matter drop. He pushed for that complex answer. Doctors can be like that. So I cleared my throat and returned his stare.

“You mean why did I raise that glass to my lips? You want to know what made me relapse?”

“Yes.”

“I had no map, I had no compass.”

“Map? Compass? I don’t understand.”

“No, you don’t.”

At that point he did avert his gaze. But only briefly. “So, can you tell me why?”

I shifted in my seat and looked out of the window. I focussed on a roof top across the street. It was raining. But I began to talk despite the rain.

“I’m grateful for the detox. Really, I am. But on its own it was never going to be enough. It was never going to be anything other than a start. And a start is of absolutely no use if you don’t know in which direction the end lies. No map, no compass, no idea of my destination. A circular route will always lead you back to the place where you started.”

“So you went out and bought a bottle of Whisky? You poured yourself a drink?”

“I did.”

“Tell me what you were thinking.”

That one was easy. I remembered it clearly.

“I saw that amber poison and swished it around in my glass. Then I smelt it. It smelled of sweet release. But God, or one of his minions, sat on my left shoulder while the devil himself sat on my right. One said yes as the other screamed no.  They are heavy souls and it’s difficult to carry them around all day and all night. They are a burden and they never shut up. And they tire me. I really was so very tired.”

“So you drank?”

“I did.”

“So the devil won?”

“You’re presuming that one is right and the other is wrong.”

“Naturally, yes.”

“You misunderstand me. I want rid of the pair of them. Their arguments are futile and meaningless. I need them to be quiet. I just want…”

I faltered. The words got stuck in my throat.

“You just want a map and a compass?”

“I do.”

BRIDGE
Any service is only as good as the philosophy that underpins its purpose and motives.

One of the things that most impressed me about Bridge, when I first chanced upon them, was a declaration of their belief that any one particular approach to recovery is no better, or worse, than another.

There would be no doctrine. No force feeding. Recovery is the responsibility of the individual that seeks it.

It seemed to me that Bridge was endeavouring to provide an environment that was conducive to recovery, but the choices remained mine. There was no judgement, there were no demands. There were no promises but there were suggestions and encouragement. There was tea without sympathy, there was hope without concrete expectation. There was a belief that recovery is as important, if not more important, than treatment. I’m convinced that one can’t work without the other.

I suppose that Bridge gave me a map and a compass. I studied the map and circled my desired destination. It was only a start, but it was a start with a realistic potential outcome. And I guess that was all I had ever needed.

I still haven’t reached my destination. To be honest, I don’t care if I never do. I’m simply enjoying the journey. Some days the sun shines, some days it rains. But no one sits on my shoulders anymore.

“His drinking led to him being unable to control both his bladder and bowel movements.”

This member was referred to Bridge in November 2020 due to his issues with alcohol.

He was attending the pub daily as soon as they were open. He would drink 6 pints and then buy more cans of lager to drink at home. He was averaging 90 cans a week. This made him extremely vulnerable to others and was being financially abused as ‘associates’ were having their drinks bought by him. Bank statements showed the financial difficulty this was placing him in. His drinking led to him being unable to control both his bladder and bowel movements.

His drinking was having an impact on his relationships with both his children and his siblings.

This member was living in shared accommodation which was not suitable for his recovery. It was established that he was not claiming housing benefit, for which he was able to claim, and had been using his pension and savings to pay for his accommodation. An application was made for housing benefit. Staff were able to scan and send all the paperwork to the local housing benefit department. Due to the covid restrictions, there was a delay with this claim. However, staff supported the member to contact them and the claim was accepted and housing benefit put in place.

The member had an open Keyways application (housing application) Staff contacted the Keyways department to discuss this application and informed them of our support and how a move would be beneficial to this person’s recovery. He has now been offered a bungalow, which he is due to move into imminently and we are in the process of applying for funding for white goods.

His self – care has improved and is showering and shaving daily, when previously he would not do this. His sister has arranged for a carer to visit twice a week to ensure he manages these daily tasks – which has helped.

Plans have been put in place to reduce the amount of alcohol the member is consuming. He has now reduced from 90 cans a week to 2 glasses of wine a day which are ‘weakened’ by putting in lemonade. Relapse prevention techniques are being put in place for when the pubs are able to reopen. The member’s aim is to be able to continue to drink alcohol socially but to manageable levels and so that he cannot be taken advantage of financially.

The member’s relationship has improved as a result of his reduction in alcohol use.

He is now regularly speaking with his son who lives in USA on the telephone, which he is really pleased about. His relationship with his sister is really positive and she is supporting him also.

His sister has been in contact with staff and thanks us for the support we have given to her brother. She has informed me of the positive changes he has made.

Member has really engaged and praises the work of Bridge, he will often make comments on how great we are and doesn’t know what he would do without us. Member will often just call for a chat as he lives alone. He will say that he is also welcomed with a kind voice which boosts his mood and is looking forward to being able to attend after the lockdown.

“Prior to joining Bridge I know that if faced with this situation then I would have had a drink and would possibly have ‘given up’.”

I first attended Bridge in January 2019. I was drinking one and a half litres of whisky a day and this was costing me over £60 a week. I did not know what to expect when I first came to Bridge but had a pre- conceived idea. When I arrived I freaked out about it as I did not think that the other members were like me and thought that I would not attend again.

Staff made contact with me to see how I was getting on and made suggestions for different activities I could join in. I came back and started attending the meditation and acupuncture sessions. I was also booked into reflexology. I found these sessions to be really beneficial to me and Julie really has healing hands!

I was diagnosed with breast cancer in May 2019 and had a breast removed. This was a really tough time for me but through attending these groups and talking with my support worker and other staff, I was able to get through this. Prior to joining Bridge I know that if faced with this situation then I would have had a drink and would possibly have ‘given up’. At times throughout the last 2 years I have had those thoughts about drink but have strategies in place to stop them developing further. This includes being able to call staff. I know that they will listen to me and support me through my struggles and I am able to overcome these feelings and this is reassuring.

The support and sessions that Bridge have provided during the pandemic has been amazing. I was able to come in for a face to face appointment when I really needed it. They really went above and beyond my expectations as most services were not operating in the same way. When reflexology and meditation restarted, I was able to come in for these sessions. There are lots of zoom sessions that we can attend and this is incredible.

My use has been hard on my family but I am now 2 years abstinent and my relationships are positive.

I have got to know other members during this time by staying longer and spending time in the café with them. I look back at my pre- conceived ideas and I feel appalled at myself. I have made some great friendships and have all the support I need. I really miss interacting with other members and having a laugh with staff and members, and look forward to returning to some ‘normality’.