As wonderful as Caswell Clinic is, the day will come for you to move on from here. Don't worry; you will know when you are ready! Some of you may feel you are ready before your Clinical Team does but eventually we universally agree that you 'no longer require conditions of medium security' which is usually what we write in our tribunal reports.
We can then look at what 'Aftercare Service' you might need. If you move on to another hospital a new team may be responsible for you straight away so you may not see much of us. If you move to a community setting (such as a staffed house) you may be lucky enough to take a Community Team with you. This is to provide some continuity and support from people who you know and who know you – we call this our Aftercare Service.
The Team usually consists of three people – a Social Worker, a Community Psychiatric Nurse and your Responsible Clinician. Hopefully you will already know these people through CTM's, family visits and the like. They will certainly know a lot about you – don't worry, this is a good thing!
Your Community Team will have different roles. All three will attend your Care and Treatment Planning Meetings and will communicate with each other throughout the time they support you. This is who they are and what you can expect from your community team:
Responsible Clinician (RC)
Usually the Consultant Psychiatrist you know well and see in CTM every week. Your RC will carry on reviewing your medication in the community. As you are now a person living in the community you will be registered with a GP and your RC will work with your GP to keep you well and happy. You may see your RC a little less than your CPN and Social Worker but your RC will continue to be responsible for you until an RC in the community can support you.
Community Psychiatric Nurse (CPN)
A very experienced senior nurse who will help you with your medication, mental health and will liaise with your new home to make sure they are supporting you properly. Your CPN will see you every week to start with but visits can get less as you get more settled.
Social Worker (Social Supervisor)
Your social worker will visit you regularly, usually alternating with your CPN. In addition to monitoring your well being and helping out with any issues you may have, your social worker has a specific role if you are subject to what's called Section 41 restrictions. If you are here under sections 37 / 41 of the Mental Health Act 1983 then this will apply to you. Your social worker will then be your Social Supervisor which means they will check you are sticking to the rules as decided in your Tribunal.
The Social Supervisor will have to write reports about you which are sent to the Ministry of Justice on a monthly basis. This is nothing to worry about as the rules are usually very simple and easy to understand. They can be different for each person but usually say you have to live in a certain place and see your Community Team regularly. There may be some rules around alcohol and drugs which you will need to stick to.
This sounds complicated but don't worry! Everything will be explained to you as we go along. The important thing is that you will have successfully completed you rehabilitation to the stage that you are ready to leave us which is a huge achievement.
By Sue Brown