MILD LEARNING DISABILITIES
Mark is 52 years old with a mild learning disability. He has lived in a flat of his own for five years prior to which he lived in a number of places including shared accommodation and supported living. He had several moves due to difficulties coping with other people or aspects of the environment such as noise. During this time however he was able to hold down a full time job as a cleaner between 2000 and 2010.
Mark has had several interests in the past such as listening to music and dancing. He used to meet his father in the pub on a regular basis but no longer wishes to do this. He has lost contact with the rest of his family and over recent years his level of activity has reduced.
Reason For Referral
Mark was referred by his consultant psychiatrist having had problems with anger control which resulted in two convictions during his 30’s. He lost his job in 2010 following an incident where he hit someone for making a mess of the toilet area he had just cleaned. It is believed that Mark was unwell and very anxious at this time finding the noise from his neighbours increasingly difficult to cope with.
In the months that followed, he became very low in mood neglecting his health, personal care and living environment. He was referred for Occupational Therapy to help him re-gain control over his daily living and to eventually increase his day to day occupation.
Mark's main goal was to return to work although he agreed that in order to achieve this he needed to regain some control and independence over other areas of his life such as maintaining his flat and looking after himself and his pets.
Occupational Therapy Assessment
Mark was first assessed in April 2010. Initially low demand activities were used to build a therapeutic relationship with Mark and to identify the barriers to his occupation. Activities included cards, board games and quizzes. Much time was spent explaining the role of the occupational therapist and gradually raising the issue of more demanding activities involving leaving the house.
Occupational Therapy Treatment
Mark began to discuss the barriers to his occupation which included not having a functioning microwave. He was gradually supported to leave the house to purchase one which was then increased to social outings involving cafe’s and bars leading to increased confidence and skill in daily activities.
More work was completed in identifying how Mark preferred to be supported. He quickly identified that he did not like to be told what to do or “nagged”. Staff supporting Mark were given advice and guidelines on how Mark preferred to be supported. Occupational therapy carried out role modelling to staff to ensure a consistent approach. Over the course of intervention Mark began to accept his support which historically he had always turned away.
This kind of encouraging approach was used to support Mark to begin doing his washing and ironing, cleaning and cooking. To support this process pictorial memory aids were developed. It was discovered that Mark responded best to clear, concrete instructions and prompts. There were often very logical reasons for what appeared to be neglectful behaviours.
As an example, Mark did not wash his clothes for several months but on further investigation it was discovered that his washing machine was not working properly and he did not know how to use it. Once he was given clear instructions about how to work the washing machine and support in doing his laundry over a few weeks he then did it independently. Concrete visual cues such as a blue line around the middle of his washing basket helped him to judge when tasks needed to be completed.
Mark was also offered support to develop his cooking skills because it became apparent that he was not following a good diet, instead choosing to use ready to eat food such as pasties and cooked chicken pieces. This resulted in Mark experiencing severe health complications and impacted on his willingness to go out.
Work was also completed to aid Mark in returning to employment. Occupational therapy worked with a range of employment schemes to facilitate this process and Mark gained a part time cleaning job as a result of this support. He also found a job on a local farm working with animals which was one of his life goals so he was extremely happy with the outcome.
Mark is now able to maintain a clean and tidy home. He regularly cleans out his bird cages giving his birds fresh water every morning, washes his clothes and irons them, hoovers and dusts.
Mark eats an improved diet and is accepting support with his cooking. He is able to do his own shopping although he is supported to plan this using a menu planner.
Mark has developed his range of interests and with encouragement will do new activities such as visits to the beach, feeding the ducks etc.
Mark's overall mental and physical health has improved significantly. He is very proud of his part time jobs. He earns his own money and looks after himself, his home and his pets with minimal support.