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Helena's story

Helena has a long history of mental illness and has been under the care of the local community mental health centre for six years. She has experienced several admissions to the psychiatric unit of the general hospital, the most recent being 12 months ago.

Helena lives in a supported accommodation house run by a private accommodation provider where she feels threatened and intimidated by the manager. She claims that he constantly walks into her room uninvited, is always critical of her and does not give her full access to her benefit. Assessments by the CMHT social worker have confirmed that these problems exist. The manager is a rather insensitive character, who appears to dislike Helena. He refuses to repair the heater in her room, and he watches the TV at high volume late into the evening. When Helena complains, he threatens to evict her. The CMHT social worker and care manager have been concerned for some time about the run-down state of the accommodation and the quality of its care, and have been investigating alternatives for Helena.

When ill, Helena has become very disorganised in her thinking and experiences auditory hallucinations of people talking about her and laughing at her. She has not experienced these symptoms since her most recent acute episode 12 months ago. Although when acutely ill Helena's thinking becomes very disorganised, at present she does not show any cognitive problems. However, she continues to have delusions that people living in her street are SIS agents who are compiling a dossier on her, and watching and recording her every move. However, she does not act on these and is no longer greatly distressed by them.

Helena's mother reports that she made a serious attempt on her life four years ago by jumping in front of a bus. She is now left with a permanent limp and some chronic pain. However, she manages to get around OK most of the time. Helena works 10 hours per week with a consumer run supported employment initiative, and does gardening and house cleaning. She likes the work when she is doing it, although she usually needs a lot of encouragement to attend. She is picked up by one of the employment workers because she is not confident about using public transport. She also attends an NGO community support facility two half-days per week for social activities, where she plays cards and participates in outings. At other times, she mainly sits in her room or watches television at her accommodation.

Helena has a case manager whom she sees each fortnight. The case manager's main concern is the accommodation problem and Helena's occasional use of cannabis with other residents at the supported accommodation. This causes Helena to withdraw more and becomes preoccupied with her delusions. The case manager says that Helena also needs regular supervision to make sure that she eats regularly, takes her medication and looks after herself.

She often needs to be reminded to change her clothes and to maintain her personal care. However, she often appears untidy and poorly groomed. However, she always cooperates when reminded and is never irritable or aggressive. Helena says she is lonely having lost many of her friends when she became ill, and has not been able to make new ones. People at her work say that she is hard to relate to and often seems to be in her own world. She does not feel able to initiate any friendships and feels uncomfortable even starting a simple conversation. Helena is feeling low at the moment, and occasionally thinks about suicide as the only way out.

Helena's progress notes

Initial assessment
Spoke with Employment Coordinator (Viv) who was concerned about Helena's increasing use of cannabis. Helena was extremely distressed about Derek, the accommodation manager who she says is a "perve". "He just comes into my room whenever he feels like it. I reckon he wants to catch me when I'm undressed. I can't do anything about it though because he's always saying he'll throw me out on the street so where else could I go?" Helena admits to using small amounts of cannabis to "calm her nerves" although when pressed she acknowledged that it sometimes makes her sick. "Wouldn't you smoke with dirty Derek around, he gives me the creeps?" Helena has a history of suicide attempts but says that while she has thought about it (suicide) she didn't think she'd do it and doesn't have a plan. When we discussed some ways in which Helena could spend less time at her supported accommodation to reduce her contact with Derek in the day time, she said she'd like to but is not confident about catching buses because people stare at her and if walks too much her foot hurts. Also she continues to suspect neighbours of being SIS agents and she doesn't like to go out too much because "when they see me they write down everything I do". Helena took me to her room which was dark, dingy and cold. The heater doesn't work and the curtains and carpet were dirty. Has been awaiting a review of accommodation via service coordination; this is now a high priority. Review date now three weeks time.
Sally Armitage SW

Two days later
Interview with Derek, Helena's accommodation manager, who believes Helena is lazy. He presents as a highly critical person and does not see Helena's behaviour as being symptomatic of her illness. I spoke with Jack, Helena's community care manager who reports that Helena smokes cannabis when she gets stressed. He says that she never does anything deliberately to upset anybody, but does require a lot of prompting to get motivated.
Sally Armitage SW

Three months later
Helena has settled well into her new accommodation. Am now seeing her monthly. Still talks about the neighbours with suspicion but didn't seem to mind discussing the possibility that at least some of them may not be from SIS. Negative symptoms remain problematic. Helena is happy to take her medication but sometimes forgets to take it. She continues to have problems with her personal hygiene. For example, she needs prompting to change her clothes but usually responds to indirect cues such as "how long since you changed your jeans Helena?"
Sally Armitage SW

Page last updated: 9 December 2008