HoNOS-secure case study written vignette - Asad

Asad is a 32-year-old Sudanese man who has resided in this country for the past 3 years after having his application for asylum granted. He is married with 3 children, aged 5 years, 3 years and 6 months. He was a member of the Sudanese Army for 10 years and is subsequently very fit. He has a poor command of the English language but is able to make his needs known. No specialist interpreter is yet available. His diagnosis is unclear.

Ten months ago, he was convicted of possessing a Class A substance (heroin), resisting arrest, and assaulting a Police Officer. He was sent to prison for 5 years, but owing to a marked deterioration in his mental state, (e.g. appearing depressed and increasingly anxious and detached), only served 9 months of his sentence before being transferred to ta local Medium Secure Unit under the Mental Health Act. While in prison, he had regular visits from two Sudanese friends. They have visited once while he has been in hospital, and it is suspected that they are involved in organised crime. His wife has refused to visit him. He has written a letter to her asking her to visit but has not had a response.

Asad will only change his clothes and attend to his personal hygiene if prompted by staff. His behaviour is becoming increasingly bizarre. He has been talking and giggling to himself and exercising vigorously at all hours of the day and night. He appears furtive and is suspicious of staff and other patients, preferring his own company. They language barrier has made it difficult for staff either to develop a rapport with Asad or to involve him in therapeutic activity. Last week’s routine urine test found him positive for cocaine and cannabis.

In the last forty-eight hours, his behaviour has become more unpredictable and threatening. Yesterday morning, he was found in his bedroom with a white powdery substance around his nose and mouth (Cocaine). Initially he refused to provide a urine sample and was very augmentative with staff. At approximately 2:45pm yesterday he asked his doctor for ground leave. When this was refused, he punched through a door next to where a member of staff was sitting. He was then placed in seclusion because of concerns that he was becoming a danger to others as well as himself. After approximately 15 minutes, his behaviour escalated dramatically, and he kicked the seclusion room door open, breaking his right foot.