Guidelines for field staff to assist people living in ... - Housing NSW

CASE 2Mr B is a 33-year-old male with chronic schizophrenia who lives alonein a DoH bed-sit. Mr B was most recently hospitalised with an acuteepisode of schizophrenia over a year earlier. He has little insight andhas avoided contact with mental health services since his CommunityTreatment Order (CTO), compelling him to comply with medication,lapsed more than six months previously. Mr B is generally suspiciousand irritable and the DoH had difficulty organising a routine inspectionof his accommodation. When the inspection was conducted, Mr Bwas found to be in a severe state of self-neglect. He has minimalfurniture, but all the walls, fixtures and surfaces are severely dirty anddamaged by cigarette burns and moisture. The bathroom andkitchen are in a particularly bad state and the floor has beenextensively damaged by water. Mr B reports deliberately leaving tapsdripping to obscure distressing persecutory auditory hallucinations.On the threat of eviction, Mr B agrees to see the mental health teambut refuses to go to hospital.DiscussionMr B has active psychotic symptoms possibly associated with noncompliancewith treatment. Living in conditions of severe domesticsqualor partly results from his psychotic symptoms. The DoH shouldtake advantage of Mr B’s consent to see the mental health team andconduct an urgent or priority assessment. Although it is likely that MrB will require re-admission to hospital until his mental state improves(to permit cleaning and repairs and application for a further CTO) itmay be possible to recommence treatment in his currentaccommodation. If required, the DoH may be able to providealternative accommodation until cleaning and repairs are completed.Based on his response to treatment and his lack of insight, it wouldprobably be advisable for the CTO to be maintained. Educating Mr Babout his condition and the need for medication and minimising anyadverse affects may improve compliance. Mr B may benefit fromattending a rehabilitation or living skills program.If Mr B’s capacity to maintain his own accommodation remains poordespite resolution of psychotic symptoms and compliance withtreatment, consideration may need to be given to group housing,where he would have more supervision and support. Otherwise,since the risk of relapse is high, ongoing follow-up and monitoring byMental Health Services or the DoH or both would be highly desirable.If Mr B had changed his mind and refused assessment by the mentalhealth team, an application to conduct an assessment under theMental Health Act 1990 may have been required. If Mr B hadcontinued to resist inspection, the DoH could have applied to theConsumer Trader and Tenancy Tribunal (CTTT) to issue an accessorder, and authorise an inspection under the Residential TenancyAct. 1997. The DoH has the right to inspect public rental properties upto four times a year.50