Kedleston Unit celebrates a seven-year journey to discharge
Derbyshire Healthcare NHS Foundation Trust's Kedleston Unit at Kingsway Hospital has recently supported the safe discharge of a patient who had been in its care for over seven years. This is a significant outcome after a prolonged and highly complex discharge process that involved careful risk management, multidisciplinary coordination and resourcefulness at every stage.
The patient had a mental illness diagnosis alongside ADHD, a history of substance misuse, and significant trauma. The different issues made progress challenging. Interventions addressing his mental illness did not always help with his ADHD, and ADHD symptoms continued to present challenges in areas like budgeting, impulse control, and daily living skills, which are the very areas that community placements typically expect people to manage. He had spent most of his adult life in secure care, which also limited his opportunities to develop independence and the skills needed for safe community living.
Several placements were identified over the years but did not progress. Each time, the patient had to adjust again. There were periods when he felt hopeless and lost motivation, and the team worked to keep him engaged through regular one-to-ones, encouraging continued use of Section 17 leave to help him build confidence in community settings and being consistent in their reassurance that the right placement would be found. His family were kept informed throughout and involved wherever consent allowed. Their views were considered at every stage of decision-making.
Neurodiversity-focused support
Grace Swindale, Clinical Lead, Forensic Community Mental Health Team at Derbyshire Healthcare NHS Foundation Trust said:
Reasonable adjustments were in place throughout the patient's admission to support his neurodiversity. These included a structured budget plan supported by both inpatient and community teams, access to a sensory 'Pod' (large sensory bean bag) during communal time and meetings, and additional support with daily living activities, with clear recognition that these needs would continue post-discharge. These adjustments were essential in maintaining engagement and progress.
A turning point came when a suitable placement was identified that could accommodate the patient's risks and long-term support requirements. The team were able to be transparent from the outset about the patient's needs to plan his care safely and collaboratively. He has now been settled there for a significant amount of time and is progressing well thanks to the support from the placement itself, a community team, and regular contact with clinical services who know him well.
Lessons learnt
The team has reflected on several key learnings from this case.
Grace Swindale said:
Some patients require considerably longer pathways to achieve a safe discharge, and the priority must remain finding the right placement rather than the quickest one. Bringing complex cases into reflective practice and external forums can surface ideas and solutions that might otherwise be missed. And when a patient loses confidence in their future, the team's role is to hold that confidence on their behalf until circumstances change.