High Dependency Care

Dalston Ward offers this service which has been developed for individuals with significant cognitive impairments and challenging behaviour who require longer term rehabilitation in a safe and predictable environment. Emphasis is placed on relational security as many patients will have complex physical and behavioural needs. In practical terms this involves accepting individuals for admission who are managed with a high staff ratio and where rehabilitation is slower than would be associated in other parts of the service at St Mary's. Patients can be admitted following a detailed pre admission assessment.

This service will offer care for those individuals who have a complex range of neuro psychiatric and cognitive impairments. They need to be physically stable on referral most will present with significantly disabling cognitive or behavioural difficulties and require specialist neurobehavioral management with a high degree of intensive supervision within a safe environment. Most patients will have presented significant challenges to service providers and will require high levels of staffing to manage challenging behaviours. The rehabilitation process will invariably be a long term intervention, due to the severity and disabling nature of the cognitive impairment. The philosophy of the service is to maximise the quality of life for individuals whilst attempting to reduce aggression and intrusive disruptive behaviour. The approach will aim to result in manageable behaviour to enable transfer to a less dependent environment for the long term. Given the needs of this patient group and the philosophy of support to improve quality of life, a high staff ratio will be maintained to enable an appropriate level of activity both on and off the ward.

The High Dependency Service will be therapeutically led by a senior Clinical Nurse with support from an Occupational Therapist. These arrangements will ensure that patient care has a focus upon activity as well as the implementation of a comprehensive cognitive and behavioural rehabilitation programme.

Dalston High Dependency Unit Admission Criteria

• Male 18-65.
• Significant Cognitive Impairment.
• Physically stable.
• Require high/constant supervision in a locked environment.
• Challenging Behaviour.
• Detained or informal.