The Acquired Brain Injury (ABI) Service is part of the wider Mental Health Network.

The ABI service at Guild Lodge has responsibility for all patients with secure ABI needs in the North West of England. We can also accept patients from the rest of England when we have beds available.

The ABI service offers integrated care for individuals who have identified secure care needs associated with brain injury. This allows better matching of care with individual patient need in a specialist area where secure ABI provision is otherwise very limited.

The combination of primary and comorbid problems, and associated risks, often means that referred patients have experienced exclusion from other services, inappropriate placement or placement breakdown. The ABI service seeks to find lasting resolutions in the provision of care for our service users.

The World Health Organization's definition of acquired brain injury:

Damage to the brain, which occurs after birth and is not related to a congenital or a degenerative disease. These impairments may be temporary or permanent and cause partial or functional disability or psychosocial maladjustment.

An ABI may be caused by external blows, jolts or penetrating wounds (also known as traumatic brain injury), stroke, heart attack, infections producing high temperatures, brain tumours, loss of consciousness, loss of oxygen to the brain from choking, near drowning or other anoxic conditions.

At the present time 1.3 million people in the UK are living with the long term consequences of brain injury.

Typical presenting needs of someone with an ABI include:

  • Executive functioning deficits
  • Insight/awareness
  • Memory and Attention
  • Communication/Language
  • Perceptual disturbance
  • Apathy
  • Emotional dysregulation
  • Cognitive fatigue
  • Occupational/Vocational/ social skills
  • Physical health needs following brain injury including epilepsy
  • Mental state (co morbidity)
  • Risk behaviours (violence, vulnerability, harm to others/selves, impulse control, offending).

The service has the following admission criteria:

  • Aged 18 or above
  • Male
  • Have personality, behavioural or emotional changes as a result of ABI and / or have mental illness as result of ABI
  • Detained / detainable under Mental Health Act
  • Suitable for secure services i.e. have demonstrated significant risk of harm to self or others or have forensic history indicative of significant risk
  • The ABI has occurred more than 3 months earlier – this allows for natural recovery from Post-Traumatic Amnesia
  • Primary diagnosis is not developmental disorder, learning disability or degenerative neurological disorder

If the admission criteria are met, the ABI service will send out its own assessment team within 2 weeks if non-urgent. This is dependent on the receipt of suitable referral information, support documentation and geographical location.

Following assessment the assessing team discuss their findings with the ABI network team which meets fortnightly and a decision is made about suitability for admission, security level, initial risk management plan, potential safeguarding concerns and most importantly a care pathway plan.

Every patient has structured clinical assessment of risk as well as situational specific risk management plans. These are reviewed and updated regularly. We also use an Electronic Risk Assessment Tool that forms the basis for individualised Situational Specific Risk Procedures.

Assessment of Cognitive Function

Each ABI ward has an allocated psychologist and associate practitioner. On admission the psychology team commence formal review and assessment of cognitive functioning.

This is a comprehensive assessment and is time intensive. However the results of such assessment enable the care team to determine bespoke treatment and psychological programmes befitting the individual’s cognitive profile.

Our occupational therapists and technical instructors complete functional assessments of independent living skills including social skills, safety assessments, and motor assessments using standardised assessment tools.

Should any communication or swallowing difficulties be identified our Speech and Language Therapist completes a comprehensive assessment.

Assessments are completed within 12 weeks of admission – however this can vary dependent on severity of cognitive impairment and comorbidity e.g. epilepsy or mental illness that can affect the process.

Every patient admitted to the service has a physical health examination, with a minimum yearly update. We encourage our patients to have routine blood screening and an ECG.

Patients with long term medical conditions are referred to the physical health care team. All patients are registered with the visiting GP. A nurse practitioner also holds weekly clinics. Support is given to all patients for smoking cessation and weight management, focussing on adopting a healthy lifestyle through education and health promotion.

All patients with epilepsy have a comprehensive epilepsy care plan. NICE guidelines for epilepsy management are followed.

Further investigations for neurological conditions can be accessed at the local general hospital (Royal Preston Hospital) e.g. EEG, MRI, SPECT.

Mental Health Assessment

There are two responsible clinicians, a neuropsychiatrist and a forensic psychiatrist with specialism in Neuropsychiatry. Each patient has assessment and regular review of their mental state. The consultants are responsible clinicians as per the Mental Health Act and therefore have responsibility to ensure detention in hospital is necessary and proportionate to presenting risk.

Approximately 70% of patients are subject to part iii of MHA (1983) including hospital orders as directed by the court. These can include individuals subject to Ministry of Justice restrictions and those transferred from the prison estate.

Medication reviews are in collaboration with the Guild Lodge Pharmacy Team who provide invaluable support and contribute to the care team meetings.

Physical Health Assessment

Every patient admitted to the service has a physical health examination, with a minimum yearly update. We encourage our patients to have routine blood screening and an ECG.

Patients with long term medical conditions are referred to the physical health care team. All patients are registered with the visiting GP. A nurse practitioner also holds weekly clinics. Support is given to all patients for smoking cessation and weight management, focussing on adopting a healthy lifestyle through education and health promotion.

All patients with epilepsy have a comprehensive epilepsy care plan. NICE guidelines for epilepsy management are followed.

Further investigations for neurological conditions can be accessed at the local general hospital (Royal Preston Hospital) e.g. EEG, MRI, SPECT.

Formulation

On completion of the assessment process a formulation meeting is held. This aims to identify and establish the following:

  • diagnosis – including comorbidities
  • neuro-behavioural rehabilitation goals
  • cognitive rehabilitation goals
  • environmental support
  • educational needs
  • interventions required – psychological, occupational, nursing
  • if further assessments are needed.

Our activities are multipurpose – they assess and provide rehabilitation in engagement, cognitive functioning, social skills, motor skills and mental health; which in turn can lead to even more specific rehabilitation interventions for the individual patient.

Our activities include:

  • daily orientation, current affairs
  • art therapy
  • social skills
  • personal care
  • pet therapy
  • cooking
  • music therapy
  • physical exercise
  • vocational skills – woodwork, metal work, bike maintenance
  • numeracy and literacy
  • basic computing

Short and long term recovery goals and targets are set in collaboration with the patient and are a key pillar of our care. Specific treatment interventions are commenced. These will largely fall in the following categories:

Maximise internal strategies

  • education
  • targeted psychology/occupational interventions
  • medication

Optimise environment

  • compensatory aids
  • specialist nursing support

Psychological interventions

  • brain Injury awareness education
  • reminiscence therapy
  • emotional coping skills
  • anger management
  • relaxation skills
  • drugs and alcohol interventions
  • voices and visions group
  • Life Minus Violence (modules for Harmful Sexual Behaviour)
  • trauma therapy
  • cognitive behaviour therapy
  • personality assessment

All of these therapies have been adapted for individuals with ABI and can be provided to individuals as well as small groups. Given the variation in cognitive impairment of our patients one to one provision is more common.