Transcript Conventions

Italicised words - those which are emphasised by speaker
/ - very brief pause
... each pause represents approximately 1 second
[ ] sections which are inaudible on the tape. Where words are written in these brackets, then these represent an informed guess as to what was said.

Text segment 1

Version 1 SNT:

We're going/ he hasn't been out for two years for any length of time this guy-for goodness sake let's give him that extra bit of time let's get him home in a chair let's get his wife organised um/ there's issues of care attendants there's the issues of the family stuff um/ and at least if he can go home and/ um/ the other thing is that his legs swell very badly when he's up for any length of time so you know there's all sorts of issues with him/ that he's a nightmare/ he's like a time bomb out there waiting to go/ so let's get him ..(Team 1)

Version 2: SNT:

We going- he hasn't been out for any length of time. This guy- for goodness sake let's give him that extra bit of time. Let's get him home in a chair. Let's get his wife organised. There are issues of care attendants. There's the issues of the family stuff. And the other thing is that his legs swell very badly when he's up for any length of time. So, you know, there are all sorts of issues with him. He's a nightmare. He's like a time bomb out there waiting to go. So let's get him .....

Text Segment 2

SW

How does Prozac seem to have been affecting him?.

SNT

He was a bit grumpy when he first came in didn't he because he's only been on Prozac for about-

WARD DR.

He's always been ah really good about once he's come here but the fact that he told me he wanted to be staying in bed/ that did drop that mood down quite a bit.

SNT

He's been really down at home/ no/ he's been really down. Not like Henry and um/ so that when you suggested to put him on the Prozac and he seems to be/ he seems to be feeling much better.

SN

He's enjoying stirring P5 along and making suggestions/ left right and centre and that's/ perking people along.

SW

But is that because he's here or because of the Prozac? She says that's helping him. I don't know..

WARD DR.

Yes it will be the environment

SNT

If he really wants to go home there's no doubt about it. He's not/ you know .. so

SW

He doesn't think enough happens up in that end room. He thinks he's been stuck away up in the end room. We put him there so we

SN

We haul him out twice a day and dust him off/ (some chuckles) take him down to the dining room and TV room.

SLT

Any more for Henry?

OT(1)

Okay/ Henry .. last time his back had been seeping um/ possibilities to overcome this were discussed and we decided it was to be looked at on the ward round/ on Thursday.

Text Segment 3

CP3

(overlapping) oh right. Well, we had a/ lovely meeting with his family yesterday afternoon/ didn't we SCP?

SCP

Yep.

CP3

It was nice meeting for the first one.

SSW 1

Yeah it was nice.

CP3

SSW1 was a coward also [...] (laughter)

SSW 1

(overlapping) I don't think [ ] (laughing) yeah just

CP3

I mean .. they seem to me like a lot of guardians with kids with head injuries might be/ slightly better advocates than most but at the same time there's anger and/ and rage at the system etc etc .. The other thing is though/ this referral to the unit. Well, I don't think we should be holding our breath and actually expecting it to work

Text Segment 4

Psychotherapist

Well I'll report on the I'll report the meeting .. soon. Perhaps I should do that now. Um/ it was an interesting meeting. It took over an hour. Ah/ there were two people from the ah brain injury unit, ah the ah clinical manager/ and um/ and the uncle ah/ and ah/ what took a long time was that the/ aah/ the uncle/ as the principal spokesperson ah/ went over the the whole history of the of the process /and um/ and in some ways it was useful/ not so much to ah/ to get the ah/ the reiteration of the theme/ but really to ah/ to establish the starting point/ um/ which I/ I in fact wasn't wasn't aware of that/ their um. What happened/ with Pat is that he was ah/ in a coma and remained so for some time and ah/ the first sign of movement was a/ was a slight movement of his um/ I think right knee and the guardians have persevered. Um/ um/ just a complete absence of of ah/ medical or any other kind of staff in the whole story but/ there's certainly no doubt in my mind that whatever they have done they have been very persistent and/ they have refused right from the outset to accept some/ um/ limitations which they say/ have been stated very flatly and very baldly. One was that Pat would not walk again and ah/ that he wouldn't be able to be as active as he is and/ so forth and so on and so forth. In some ways the impression/ at the end of ah/this quite long drawn out meeting was that ah/ ah they were tremendous advocates for a severely ah brain injured person and ah/ you would want them/ on your side if ah/ something like that happened um/ However the/ what's going to happen is that/ the um/ the ACC (Accident Compensation Corporation) will be requested by ah/ the Brain Injury Unit to/ to set up a formal assessment/ um/ of Pat ah/ complete assessment um/ um/ of his ah/ to establish a kind of baseline ah/ clear baseline where he's at. That includes um/ occupational therapy/ physio therapy. This will all be done by people who come into do that to do the assessments and ah/ on the basis of that they'll ah continue to negotiate with ah ACC as to his/ um/ suitability for the unit um/ which they hope will be established next month. They were going on later that day to/ talk to ACC and it seems to me that in/ the current political climate there's a fair chance that they'll succeed in in getting the funding to establish. Ah, they have a/ they have an option on a building somewhere in the central city area aah which ah/ they're able to retain ah for about a month or five weeks / ah/ so that's the kind of operating so we'll know relatively soon whether this is going to happen or not. They've got quite a large/ staff or a potential staff and they've actually or they must have a certain amount of confidence in it coming through because they've already started the process of/ staff training . Ah/ the unit/ they have a/ they have a secure ward within a 100 bed private hospital and this campus will be/ located in in a separate/ place. It won't be as secure as as this/ ah unit here. It will have um/ a much more discreet ah perimeter fence than we have around here and um/ the/ the unit itself will be locked but the individual rooms will not be locked/ um and they intend to base them/ to move out a lot into the community aah/ ah doing a whole range of activities. So um ...

TextSegment 5

5th Review: CP3

The other thing is though/ this referral to the unit. Well, I don't think we should be holding our breath and actually expecting it to work because I I've had a very long conversation with the ACC case worker and I I'm I'm suddenly completely confused as to to what what process is/ needs to happen for him to get to unit. It seems to me like ACC are going to drag their feet/over it unless we can get many many of the legal issues/ very clearly sorted out first/ and it would/ so it seems that I need to talk to the Director about that/ now and get that sorted out. As far as him having a further assessment - I was under the impression that the unit wanted an assessment.

Psychotherapist

That's true/ and they not only want it/ they need it.

CP3

And then ACC were/ were then going to arrange and pay for that?

Psychotherapist

Well/ it' that's just the second step in the process. The first step is the/ ACC head office

CP3

Yes

Psychotherapist

Has to agree to funding the/ the ah the unit. Until that happens the rest of it/ you know the/ actual assess the assessment and so forth are extremely hypothetical and the local caseworker probably doesn't know.

CP3

No she doesn't.

Psychotherapist

Yeah.

CP3

She/ she in fact said that herself, that it it was/ it was happening at a higher level (softly) than her.

Psychotherapist

Yeah.

SCP

And my understanding from the past, SSW1 is that ACC has said this is a mental health issue (softly) and they weren't going to do anything.

SSW 1

Yeah it's a very complicated issue um

CP3

(overlapping with SSW1) Well it's made very complicated.

SSW 1

There there's the fault in us though which you must understand they/ [ ] which means and the other bit of a problem [..] is now, is the facility there and that's the problem/ so so we have to work through the highest level.

CP3

Well good on them!

SSW 1

We we wouldn't know a lot about that.

CP3

They've got another problem/ that that in fact the uncle talked about sort/ ah/ sort of peripherally and that is that ACC won't put money into it unless they're going to get a result (he speaks over someone else) so it's um/ unless this this-

CP3

is the thing we're looking at. Unless this guy/ can be rehabilitated/ and is going to improve/ they won't fund it despite the fact that .. they could improve his quality of life hugely and maintain him at his current level which to all of us is a pretty acceptable outcome. They wouldn't they wouldn't accept/ they won't buy that/ from what/ this woman was saying yesterday.

Text Segment 6

SW

Um .. no, I'm a shrink (laugh) but I/ I just like to say that/ you know for one night when he's actually/ pushing people over the edge /overall/ I think he's had enormous benefit for others-

SN

-oh he does he does-

SW

-residents here/ and he definitely has kept/ people going and/ in a really positive ways and I think we need to make sure that just because one night he's over (yes) he's over the top (that/ that's fine) we don't actually sort of say that-

SN

-and then on the other side he initiated this conversation (mm) which allowed people to/ sort of start saying and thinking about (softly) oh yeah well ..

SNT

You're quite right.

SN

Yeah

SW

And he brings a lot of humour into the place too

SN

Yeah.

SNT

But you are quite right/ it is tied to his wife suddenly going off and that. What he/ what she does at home- leave him alone with the care attendant/ and he's alone all night/ and he can't stop her and she won't say where she's going/ she's got (softly but with emphasis)enormous frustrations and problems herself actually (louder) (mm mm) and I try to grab her every so often but it's like/ it's look holding on to a moon? / I just ....

WARD DR.

Mmm/ how's the ankle swelling?

SN

His ankles?

WARD DR.

They were/ swollen slightly and I was wondering whether with the stockings and so on/ but it's nothing is it?

Psychotherapist

the meeting finished with um/ with a degree of warmth ah about the um/ um the Unit's care/ ah for Pat and ah/ ah the view that this wasn't really/ the/ kind of appropriate place for him to be um/ and um/ ah/ some where buried in the middle of that is somewhat/ somewhat worrying um/ the indication that/ Pat didn't really attack anyone (2 people comment simultaneously) and that this woman somehow attacked herself.

CCP

Are you up/ with Pat, CP3.

CP3

Yeah yeah he was here before I left yeah ...

UM

Okay next .

Text Segment 7

Psychotherapist

As you as you probably all know his uncle has this idea that if he continues to stimulate Pat's memory/ his memory will develop some form of collateral system that will/ regenerate his memory, you know, short and long term memory. (Well maybe it's-) It tends to is annoy him

SCP

If they can access part of the memory and stimulate activity/ like he may remember things he's done in the past like in doing them now. It is quite likely I think that that will happen because I don't think that he/ [that the ] amnesia goes all the way back. It's quite substantial it's-

Psychotherapist

[] mm

SCP

Could be/ if we stimulated activities around the brain you know/ has to be

N1

The question is he going to do it? Ah CP3 also had/ it frustrates him because he can't answer the questions his uncle asks him all the time and

Psychotherapist

But you're not going to stop his uncle from doing it because he's basing it clearly on the/ on the way in which he was able to/ in which he was responsible for Pat's physical recovery by the the fact that he's saying/ he's saying so/ you're not/ you're not ever going to shift that out of his-

DM

-you know if it agitates and irritates Pat then it raises some concerns for the nursing staff [ ] if you know/ I think we do need to discuss it with them.

Text Segment 8

SNT

We're going/ he hasn't been out for two years for any length of time/ this guy-for goodness sake, let's give him that extra bit of time, let's get him home in a chair, let's get his wife organised um/ there's issues of care attendants, there's the issues of the family stuff um/ and at least if he can go home and/ um/ the other thing is that his legs swell very badly when he's up for any length of time so you know there's all sorts of issues with him/ that he's a nightmare/ he's like a time bomb out there waiting to go/ so let's get him ..

SW

mm, but can we be consistent about what we tell/ what we tell him about that because ... all the 'when am I going home?' bit goes around everybody, and .. if he/ if he starts to/hear different/ different stories (mm) he will/ play everyone off.

SNT

How can we tell him?

SW

No/ well either we - that's what I'm saying. If, if we don't know let's all be consistent about not saying.

OT(2)

Anything?

SW

Anything definite (mm) because he'll hang on to that and he'll be really disappointed.

WARD DR.

Oh he's very crafty/ he just goes on and on and gets you/ down.

SW

That's exactly what I mean.

WARD DR.

And/ he he does that but then again [ ] also for the fact that you've got to go by day by day. You can't/ [ ] can't say what it will be end of the week or even next week and he accepts that

SLT

So we've got some clarity on what he/ what level he even needs to reach before he goes home/ so if we give that clarity to him (mm) so he's got an understanding he needs to boom boom boom (mm) to be whatever and then he-

WARD DR.

-we couldn't just

SLT

[....]

WARD DR.

[..] just can't be sure how he's going to progress (right)

RS

I think you've got to let him know though/ how you are going to do the assessment process about

SLT

How do you mean?

RS

He's got to have some sort of/ little goal ah/ no landmarks (mm) and even if we said, 'Well we/ ah we would like to see you/ what you're like up in the chair/ increasing periods of time/ and we'll assess it in two weeks (mm) but/ but in saying that it depends on how things are going as to/ as to how we should look towards going home'. But you can't leave it open ended otherwise he'll just go/ he'll get more depressed .. if everybody holds off and says, 'Oh/ we can't talk to you about that', (mm) /and that's sort of secret ah then/ then he will just sit there and go 'Aaah'/ or crawl back into the shell and [just stay asleep]/ I mean you've got to give him some sort of look for the future/ even if it's just to say there will be an assessment in a certain period oh well/ if two weeks is appropriate we'll go in two weeks.

SLT

All right we'll go with that.

OT(2)

Is two weeks appropriate?

RS

Oh yeah/ or shorter or longer or

SN

Assessment in two weeks doesn't mean to say he's going home. It's going to be looked at.

RS

Yeah.

SW

Is there a bed for him? I mean is that okay ... because he's aware of the bed situation too.

OT(2)

Because his intermittent care bed/ finishes today.

SW

m mm

SLT

Does he not need more clarity than that? I mean .. do we have a clear understanding of what/ what he needs to get to that point? If we do/ why not share that with him?

RS

Yeah/ yeah would have thought so/ but that's what we're talking about.

SNT

He is actually/ up in the chair for most of the day. ...............

SNT:

Henry: continue to mobilise slowly/ very small blood blister/ On great toe from his stocking. Discussion/ re mood/ ah/ wheelchair reviewed by OT and physio. Comfort/ cushion unsatis/factory . and the psych registrar was going to see him.

CNS

(softly) I keep forgetting her name. (more loudly) What is it?

Text Segment 9

SN

(softly) Yes I know. (More loudly) Anyway Henry's mood. I was going to talk/ sometimes he's quite depressed and/ he sort of gets when he gets down to the dining room he gets shit stirs and caused quite a problem one night ... because he likes to spark everybody/ but then he started picking on Geoff and Geoff got quite angry and quite upset about it/ and now and somebody said to / to him, 'Now you knew you were/ what you're doing. Why didn't you stop? You've just got to can it/ control it'. Um (softly) and he was quite angry himself (louder) but then I discovered that his wife had been in to see him on Friday night for two minutes and pushed off to New Plymouth for the weekend and didn't tell him/ she was going to New Plymouth for the weekend ..

SNT

There's no change. There are huge marital problems.

SN

They're still/ yeah.

SNT

All of them insoluble/ and um

WARD DR.

But then it's not fair to take it out on the other residents here.

SN

No it's not/ it's not fair to take it out and he knows that/ but he said he felt he couldn't help himself,

WARD DR.

(overlapping last words) in that case he's got to be/ I mean he's to to- does somebody take him back to his room?

SN

I've done that/ I've taken him from the dining room when he starts picking/ I say. 'Out/ get him out'.

WARD DR.

I can see on the ward round too, he's just waiting to pick on the surgeon or somebody (yes)/ and he just loved that. You see he just wants us to be/ doing that arrangement for the/ the TV so that somebody else could see that. The poor house surgeon running around trying to adjust that TV in the corner and then he's getting everybody running around as usual but it is okay to be just the once off/ that's fine/ but not with other residents who can't handle that you know/ that's really not/ help themselves

SN

Unfortunately it was Geoff .. threw the angry /and got told off until we discovered that Henry was the/ culprit.

SNT

As usual.

SN

But/ but on the/ on the positive side Henry's started really interesting um/ talk with/ everybody last week/ and he got them talking about what they would like when they die, what music they would like at their funeral which (raises pitch of voice) I actually thought was really helpful (drops pitch)/ for/ for/ for them to start actually thinking about it and and actually it was a/ it was a fun conversation but they/ Kath was saying, "Oh I like this' and 'I'd like that' and somebody else was saying, 'Well I'd like this'. (mm)/ but it was/ it was an interesting conversation.

WARD DR.

Yes. Oh that's all right. It's just like Henry isn't it/ to have thought of that .

yeah

SNT

Well it's like him because he's starting to be quite suicidal at home .. um/ really for/ the the first time I've seen him as bad as/ as that um .. and that .. was why he went on the Prozac/ he's never really /needed an anti-depressant and things are very bad at home (mm) and he's/ he's made a huge effort/ to try and/ resolve some of the marital stuff and/ and and move on a bit .. and he's got/ gets frustrated all the way along/ this is -

WARD DR.

-and here was this young man/ who was a league player and the activity was his/ soulmate and then suddenly he's/ stuck down/ lying in the back room.

SNT

(to SW) Have you talked to him about this while he's in?

SW

Um .. no, I'm a shrink (laugh) but I/ I just like to say that/ you know for one night when he's actually/ pushing people over the edge /overall/ I think he's had enormous benefit for others-

SN

-oh he does he does-

SW

-residents here/ and he definitely has kept/ people going and/ in a really positive ways and I think we need to make sure that just because one night he's over (yes) he's over the top (that/ that's fine) we don't actually sort of say that-

SN

-and then on the other side he initiated this conversation (mm) which allowed people to/ sort of start saying and thinking about (softly) oh yeah well ..

SNT

You're quite right.

SN

Yeah

SW

And he brings a lot of humour into the place too

SN

Yeah.

SNT

But you are quite right/ it is tied to his wife suddenly going off and that. What he/ what she does at home- leave him alone with the care attendant/ and he's alone all night/ and he can't stop her and she won't say where she's going/ she's got (softly but with emphasis)enormous frustrations and problems herself actually (louder) (mm mm) and I try to grab her every so often but it's like/ it's look holding on to a moon? / I just .... .....................

3rd Review Meeting

OT(2)

Okay is that all for Duncan? . Henry . that [tarin] tincture started seems to be/ improving and that's to the/ area on his buttocks that is seeping ... the supra pubic/ is mucky .. and Ward Dr. is going to follow that up. The area on his ankle's almost healed and his mood seems a bit depressed/ and he can cause . trouble in the dining room at night although there's um/ a positive to that he's also cheerful and can cheer up all the others this way. ................

4th review meeting:

SW

mm, but can we be consistent about what we tell/ what we tell him about that because ... all the 'when am I going home?' bit goes around everybody, and .. if he/ if he starts to/hear different/ different stories (mm) he will/ play everyone off.

SNT

How can we tell him?

SW

No/ well either we - that's what I'm saying. If, if we don't know let's all be consistent about not saying.

OT(2)

Anything?

SW

Anything definite (mm) because he'll hang on to that and he'll be really disappointed.

WARD DR.

Oh he's very crafty/ he just goes on and on and gets you/ down.

SW

That's exactly what I mean.

TextSegment 10

Review 2

Psychotherapist

Well I'll report on the I'll report the meeting .. soon. Perhaps I should do that now. Um/ it was an interesting meeting. It took over an hour. Ah/ there were two people from the ah brain injury unit, ah the ah clinical manager/ and um/ and the uncle ah/ and ah/ what took a long time was that the/ aah/ the uncle/ as the principal spokesperson ah/ went over the the whole history of the of the process /and um/ and in some ways it was useful/ not so much to ah/ to get the ah/ the reiteration of the theme/ but really to ah/ to establish the starting point/ um/ which I/ I in fact wasn't wasn't aware of that/ their um. What happened/ with Pat is that he was ah/ in a coma and remained so for some time and ah/ the first sign of movement was a/ was a slight movement of his um/ I think right knee and the guardians have persevered. Um/ um/ just a complete absence of of ah/ medical or any other kind of staff in the whole story but/ there's certainly no doubt in my mind that whatever they have done they have been very persistent and/ they have refused right from the outset to accept some/ um/ limitations which they say/ have been stated very flatly and very baldly. One was that Pat would not walk again and ah/ that he wouldn't be able to be as active as he is and/ so forth and so on and so forth. In some ways the impression/ at the end of ah/this quite long drawn out meeting was that ah/ ah they were tremendous advocates for a severely ah brain injured person and ah/ you would want them/ on your side if ah/ something like that happened um/ However the/ what's going to happen is that/ the um/ the ACC (Accident Compensation Corporation) will be requested by ah/ the Brain Injury Unit to/ to set up a formal assessment/ um/ of Pat ah/ complete assessment um/ um/ of his ah/ to establish a kind of baseline ah/ clear baseline where he's at. That includes um/ occupational therapy/ physio therapy. This will all be done by people who come into do that to do the assessments and ah/ on the basis of that they'll ah continue to negotiate with ah ACC as to his/ um/ suitability for the unit um/ which they hope will be established next month. They were going on later that day to/ talk to ACC and it seems to me that in/ the current political climate there's a fair chance that they'll succeed in in getting the funding to establish. Ah, they have a/ they have an option on a building somewhere in the central city area aah which ah/ they're able to retain ah for about a month or five weeks / ah/ so that's the kind of operating so we'll know relatively soon whether this is going to happen or not. They've got quite a large/ staff or a potential staff and they've actually or they must have a certain amount of confidence in it coming through because they've already started the process of/ staff training . Ah/ the unit/ they have a/ they have a secure ward within a 100 bed private hospital and this campus will be/ located in in a separate/ place. It won't be as secure as as this/ ah unit here. It will have um/ a much more discreet ah perimeter fence than we have around here and um/ the/ the unit itself will be locked but the individual rooms will not be locked/ um and they intend to base them/ to move out a lot into the community aah/ ah doing a whole range of activities. So um ...

CCP

In there/ do they take special patients?

Psychotherapist

And they/ they may-

?

(very softly) -Or will they take special patients?

Psychotherapist

They they say that they will but they are reliant on/ us doing our bit with the Ministry ah/ while they do their bit with ACC ((s) mm) and in a more general sense ah with the/ with the Ministry /but they're relying on/ um/ us to make the/ overtures because we know the people we know the processes/ ah which they don't. So they're certainly looking at taking ah special patients yes.

UM

We've probably actually/ need to flag that with ah/ {Legal Services} (yes) to see what their opinion is about that because of his short/term /of his being a special patient.

CCP

Presumably he could stay a special patient (softly) though. It's a hospital we're talking about.

UM

Legal Services might have to get it to the director though.

CCP

Oh okay ... okay.

UM

mm hm .. (okay) maybe we should probably check out (softly) that with Mary and I mean he doesn't/Pat doesn't require medium security he requires 24 hour supervision.

Psychotherapist

that's what will be supplied in this ah/ in this unit. It will be quite intensively staffed /and it will have a/ a/ quite a high level um of ah/ patient activity .. so um I I assured/ the um/ the guardians that ah we would ah that if the opportunity arose ah/ for Pat to ah to transfer to that unit that we'd be very supportive of that and ah/ they'd ah

CCP

we'd be very supportive I guess (general laugh) we'd even pay for the escort to get him there.

Psychotherapist

(softly) yeah ah/ I mean that that's that seemed to/ I/ you know in the context of what's happened they say they say that they've had/ a lot of difficulty with people being/ initially/ from a um/ a medical survival and mobility point of view extraordinarily gloomy um/ prospects and that um/ if they hadn't adopted a kind of 24 hour guardian role um that / that Pat would be much less active and he/ the uncle ah/ described the situation where/ a physiotherapist um in a kind of a/ gymnasium ah situation had said that it wasn't that it was neither possible for Pat to walk/ or ah/ practicable or even permissible / for ah Pat to scale the wall and wherewith the uncle/ umm took up the challenge and encouraged him to scale the wall (softly) and so forth so I mean that's/

UM

I mean while they/ maintain that ah without them he wouldn't be where he is today/ a Rehab Unit actually did the majority of his rehabilitation (mm/ of course/mm) so you know then they need to feel like they are the/ the pivotal

Psychotherapist

(softly) That's right yeah/ that's right. (more loudly) um and you know/ wherever he goes that's going to be/ that's going to be the/ the dynamic that the carers/ have to put up with and-

UM

-Well-

Psychotherapist

-And really it's a/ it's it's nicely placed in the context of how they described both Pat and the family process pre the accident and it's really just a continuation (softly) of that.

UM

Well hopefully the new unit will take him and we won't have to worry about it too much........................................

Psychotherapist

the meeting finished with um/ with a degree of warmth ah about the um/ um the Unit's care/ ah for Pat and ah/ ah the view that this wasn't really/ the/ kind of appropriate place for him to be um/ and um/ ah/ some where buried in the middle of that is somewhat/ somewhat worrying um/ the indication that/ Pat didn't really attack anyone (2 people comment simultaneously) and that this woman somehow attacked herself.

CCP

Are you up/ with Pat, CP3.

CP3

Yeah yeah he was here before I left yeah ...

Review 3:

Psychotherapist

Has he ever said that before? "Anyone would think that I've attacked someone"?

CCP

Yeah he's said it.

N3

Oh he's said a few times.

CP3

He said the same thing to me.

UM

He does a lot of [.] (speakers overlap briefly)

Psychotherapist

What what do you say when he says that?

UM

"Yes well you did".

Psychotherapist

Yeah/ I think that's (overlapping) just that it's really important to say that even with all of the/ the difficulties of retention and all the rest of it.

UM

And then five seconds later he doesn't know that he's said anything.

Psychotherapist

(overlapping) Sure but even so/ I think-

SSW1

-well it is far better/ far better actually ah to [.. ] sometime.

Psychotherapist

That/ I mean that it it's interesting in the context because of the/ in the meeting with his guardians the other week ah/ his uncle very clearly raised doubts about whether he in fact attacked anyone . I mean that's the/ that's the kind of stuff that-

SSW1

(overlapping) well that-

UM

-it's historical.

Psychotherapist

"He hasn't assaulted anyone. It's really open to question". He doesn't quite say that she assaulted herself but that's what he's saying and it's really quite interesting that that-

UM

-that's the kind of/ thing they've maintained for/

SW

mm

Psychotherapist

Sure.

UM

Is he um .[on a 2 to 1 ratio]?

Fourth review

CNS2

We have to find out too about um/ if /all the patients have a um/ personal folder. Pat hasn't got one and in in the information personal folder in ah/ in um keeping up with um section papers and ah management plans and um/ patients rights information that that sort of thing. I'm just wondering what the MDT think about Pat having that information and it's like um while his section papers that do have information um/ of what he was charged with etc um/ whether that would help or hinder him/ or whether that information could be perhaps passed on to the guardians instead ...

N1

I think in a way it's almost cruel for him to come across information like that all the time because every time he sees it it's something new to him.

DM

Yes.

CNS2

It's information that

N1

(softly) Because [he says I can't have done something like that].

CNS2

You know just/ yeah yeah.

N1

So you know and and he continuously asks-

?

-it might be easier

N1

(raises tone of voice) he has days when he asks, "Why am I here"? you know (drops tone) and half an hour later he will say, "Why am I here"?.

?

mmm/ that happens.

N1

His latest theory is that somebody else has done something that he's being blamed for so

Psychotherapist

well I mean that's the point of view that his uncle in particular takes so if it's constant/ he'll be being reinforced from that

N1

That's/ oh/ (raises tone) I haven't heard his uncle (drops tone) say anything like that [.].

UM

I mean the whole idea of the personal files for the clients was to/ give them some input into what happens to them here and why they're here and things like that. I don't know that he would benefit for that for (no) the reason that you were talking about.

Psychotherapist

He doesn't/ he just does not know.

UM

Possibly the guardians might benefit from having his personal file.

5th review

CP3

(overlapping) oh right. Well, we had a/ lovely meeting with his family yesterday afternoon/ didn't we SCP?

SCP

Yep.

CP3

It was nice meeting for the first one.

SSW 1

Yeah it was nice.

CP3

SSW1 was a coward also [...] (laughter)

SSW 1

(overlapping) I don't think [ ] (laughing) yeah just

CP3

I mean .. they seem to me like a lot of guardians with kids with head injuries might be/ slightly better advocates than most but at the same time there's anger and/ and rage at the system etc etc .. The other thing is though/ this referral to the unit. Well, I don't think we should be holding our breath and actually expecting it to work because I I've had a very long conversation with the ACC case worker and I I'm I'm suddenly completely confused as to to what what process is/ needs to happen for him to get to unit. It seems to me like ACC are going to drag their feet/over it unless we can get many many of the legal issues/ very clearly sorted out first/ and it would/ so it seems that I need to talk to the Director about that/ now and get that sorted out. As far as him having a further assessment - I was under the impression that the unit wanted an assessment.

Psychotherapist

That's true/ and they not only want it/ they need it.

(Later) UM

Is there anything else relevant that came up at that meeting? I mean the medical issues? [You guys raise those issues with them, talk about that here-]

SSW1

Well the ah-

UM

(overlapping) until the cows come home.

SSW1

well [.] an xray information there and we are-

UM

- no moans groans complaints?

SSW1

[..]

UM

(overlapping) compliments

SSW1

No no no. They were fairly nice people I mean

CP3

(overlapping) Actually quite a few compliments

SSW1

Very nice they're very nice

CP3

(overlapping) and no real complaints.

SSW1

No no there wasn't any.

SCP

No.

UM

That's good.

SSW1

[..]

UM

(very softly) oh good had heaps today (chuckles)

CP3

And they're getting in a big lawyer to look at Pat's case he's got-

SCP

-and to what end/ it's not clear. I mean they sort/ they're a little bit confused when they talk about issues. I sometimes get a bit lost about what their point is but/ ah I think that is to follow up the idea that the/ person Pat attacked had so much grass in her system when she was assaulted. I don't know how they would assess that given the depth of her wounds, she must have lost a lot of blood you know

(Later) Psychotherapist

there's a certain amount of difficulty in [relation to the stabbing) ] about what you were saying ah/ since it's his uncle's friend who taught him all that.

SSW1

What!

Psychotherapist

Well his uncle's friend is the one taught him all the hunting skills.

SSW1

I knew that.

Psychotherapist

And/ it's very difficult I think to approach that ah directly or even indirectly with the with his uncle.

SSW1

What [...]

Psychotherapist

I know that/ I'm saying it's very difficult in terms of of what to do about this gesture that he made when he was out/ ah the other day it's all part of a/ mm it's part of a process that's infinitely bound up with his relationship with his uncle and his uncle's friend.

SSW1

And he should know that. He should be well aware of this but it's important to [.. ] clarify the issues] the dangerousness

SCP

And I think that that's something we're actually going to have to address with him.

SSW1

That's right.

SCP

And I think we need to think very carefully about how we are going to do that.

SSW1

Exactly.

SCP

mm

SSW1

Well I come[...]

PR2

Sure

UM

Okay ...

END OF DISCUSSION

Text Segment 11

UM

I mean while they/ maintain that ah without them he wouldn't be where he is today/ a Rehab Unit actually did the majority of his rehabilitation (mm/ of course/mm) so you know then they need to feel like they are the/ the pivotal

Psychotherapist

(softly) That's right yeah/ that's right. (more loudly) um and you know/ wherever he goes that's going to be/ that's going to be the/ the dynamic that the carers/ have to put up with and-

UM

-Well-

Psychotherapist

-And really it's a/ it's it's nicely placed in the context of how they described both Pat and the family process pre the accident and it's really just a continuation (softly) of that.

Text Segment 12

Psychotherapist

the meeting finished with um/ with a degree of warmth ah about the um/ um the Unit's care/ ah for Pat and ah/ ah the view that this wasn't really/ the/ kind of appropriate place for him to be um/ and um/ ah/ some where buried in the middle of that is somewhat/ somewhat worrying um/ the indication that/ Pat didn't really attack anyone (2 people comment simultaneously) and that this woman somehow attacked herself.