Appendix 5. Reece Penfold* - Case Study

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1 History and presenting issues: Reece Penfold* - Case Study Reece is a Lewisham client. Late 0 s male who has a history of prolific violent offences and ongoing mental health issues. You First started working with him when the NHS service that had been addressing his mental health had to stop seeing him as he no longer fit their criteria but they were extremely keen for our service to work with him and could not speak more highly about him. At the time of his referral he had 3 separate court cases on the go for separate offences, he was also a variety of court orders/tags/probation/community service/police signings etc This dual nature was the first thing I struggled to comprehend when I first started working with him. On the one hand we had a long history of criminal offences and substance use, on the other hand you had workers from various services telling me what a polite and dedicated person he was and how he would benefit from a fresh start. Around the time I started working with him he had also completed a college course to access employment with Network rail and he had finished top of his class, and his tutor told me that if he sorted his life out he could easily gain employment. Work Done: Initially work was done around stabilising and co-ordinating services. Reece was caught in a cycle of substance use/mental health issues/offending. We Linked in his GP/Mental health team/offender management and formed a joint care plan Met with Reece s family to establish better home relations and build his support network. Advocating at court on his behalf and explaining not excusing his behaviour. Also co-ordinated between the various solicitors and ensured Reece was at court on time and complying with court orders. Helped Reece maintain his sobriety by addressing his concerns and using his budget on diversionary tactics. Supporting him to access education and enter full time work. Housing: Reece was in a semi- independent property but was on his final warning when we started working with him. Reece had been in several fights with other residents and saw no other option than returning to the streets. We met with the housing manager and addresses both their and Reece s concerns and agreed a solution. Reece has subsequently paid off his service charge arrears (out of his own money) and is now doing well enough that they are referring him to clearing house (his own independent property) Mental Health/substance use: Has re-engaged with his medication and along with his reduction in substance use reports having a much improved state of mind. Since December 015 has been abstinent of all substances (apart from a - day blip in February 016) this is all integrated to his mental health and offending. The last blip occurred when he was arrested for an offence he did not commit, this led to him rapidly spiralling out of control and going on a weekend bender. Most importantly he pulled himself out of this and did not continue to drink or offend. He was suffering from a great deal of paranoia after that weekend and Reece would normally have dealt with this by self-medicating with further drug use. We were able to speak to him on the phone and meet him in person whenever these concerns flared up and keep him focused on moving forward towards employment.

2 Offending: In the last months we have finally come to the end of what where several ongoing court cases. He has been arrested only once this quarter (court case to be held in October 016) and he has completed his community service and court orders successfully. Offending has taken up a large part of his adult life and has acted as a replacement for a normal social circle. We are using our team s ability to spend longer amounts of time with a client and access to his budget to engage him in other meaningful activities. Personal Budget Spend The majority of spend to date is in phase Entered phase around December 015, Reece started to show a fuller understanding of his budget and how to use it and together we started to make long term plans on how to turn his life around. In his initial phase most of his spend was around acquiring clothes to smarten himself up (tied to his OCD and his love of being clean and smart ) and on travel to get to all of his various appointments Part of the trouble of using public transport was that the same certain bus routes that Recce used tended to be the same ones that others in his (anti) social circle would use, i.e. people he had grown up with/offended with/got into fights with. He used his budget to buy a bicycle, which now uses to get around to local appointments, and we spent the best part of an afternoon in the shop discussing with the staff which one would be best for him weighed against the risk of it getting stolen if he went for one too expensive. It was the first time that Reece showed insight into the fact that this was his budget, his money, but with that came the risk and reward of spending it properly. He still uses his bike regularly and at night he keeps it safe in his bedroom. The biggest breakthrough with his budget came at a critical period in RP life, he had gone a chaotic period of several related court cases and associated short stints in prison on remand. On his last spell in prison he was kept on remand for almost 6 weeks and was effectively detoxed. Once freed there was a fairly stark choice between spiralling back into a pattern of alcohol and drug use which would inevitably lead to lengthier sentences or, as he really wanted, he could pursue his dream of working as a rail safety engineer. Through all the courts cases and substance use Ricky had managed to put himself through a network rail apprentice scheme with a college in Croydon. He had passed every module required off him and was top of his class and was ready to be put forward for employment. However, the engineering company who were due to sponsor him where made aware of Reece s prescription for mental health medication and requested a letter from his GP certifying he was fit for work on this medication. His GP felt uncomfortable committing to this and failed to sign him off. At this point Reece was crushed, he had spent the last year of his life working towards this and had seen it as his only route out of the cycle of drug use and offending. Using his budget, we were able to access a private occupational health company (approved by network rail) initially this was not suggested to us as due to the cost it is normally out of the reach of most people. The occupational health signed him fit to work and this led directly to Reece due to start employment shortly as well as 4 months of sobriety. Reece has been looking in to how to use his budget on things to keep him occupied, such as fishing, computer gaming and more increasingly model building and crafting. Most importantly for Reece his budget acts as second chance. As long as he has it we always know we have a choice, if something goes wrong, if a bump comes up the road, we know we have a sum of money that we can access and between us figure out a solution. To someone like RP who has spent all his life suffering from OCD and mild psychosis, this safety valve is enough of a release in the back of his mind to keep him moving forward.

3 Monitoring and personal budget spend RP - New Directions Team scores at 6 monthly intervals during engagement with You First Team New Directions Team Scores ranked 0 to 4 (0=positive; 4=negative), risk to and from others are double weighted To date Reece has had only one NDT assessment and outcome star We suspect a link between a high score for risk to others and impulse control Engagement with frontline services 1 Intentional self-harm Unintentional self-harm 3 Risk to others 6 Risk from others Stress and anxiety 3 Alcohol / Drug Abuse 3 Social Effectiveness Impulse control 4 Housing 1st 6m as Beneficiary

4 RP - Outcome Star scores at 6 monthly intervals during engagement with You First Team Managing Tenancy & Accommodation Meaningful Use of time Offending Motivation & Taking Responsibility Self care & Living Skills Managing Money Social Networks & Relationships Emotional & MH Drug/alcohol Misuse Physical Health 1st 6m as Beneficiary Outcome Star High scores in money management and self-care but low in managing his accommodation and emotional mental health, these are likely linked to frequent alcohol binges.

5 30,000 5,000 0,000 15,000 10,000 5,000 0 Service Use Costs RP Cost of Service Use Prior 1 year average 4,600 Ongoing quarter 1 Engagement with You First 13,611 4,600 6,150 13,611 Ave 1 Year Prior Ave Q Prior Q1 Ongoing Reece has been engaging with the You First team for 1 quarter Whilst RPs year prior costs did not meet the 5,000 threshold, discretion was used to justify making him a beneficiary Average quarter prior costs 6,150 Including the cost of the You First Team, there has been an increase of 7,461 (11%) from 1 average quarter prior to 1 quarter ongoing costs Increases include: o Arrest he was arrested 4 times for one offence o Court o Community drug support Decreases include: o Hostel o Probation o Psychiatrist o Rehab Item Ave 1 Year Prior Ave Prior Quarter Q1 Ongoing Assessment Centre - Lewisham Hostel - day time staffing, ,391 Tagged 1, ,638 Arrest ,43 Police Custody Magistrates - Ave. Cost Crown Court - Ave. Cost 0 0,147 Probation 5,083 1,71 0 Supervised on Licence post Custody A&E visit not leading to admission Hospital inpatients Counselling or Psychotherapy CMHT Inc. CPN (NHS community mental health team) Mental Health Outpatient Psychiatrist 5,356 1,339 0 Community Drug & Alcohol Support ,586 Residential Rehab 4,014 1,004 0 Detox with NHS AAU (OLD), You First Team* 0 0,646 * You First Team costs are currently worked out on a monthly basis. It is planned to analyse further to produce an hourly rate per beneficiary for greater accuracy and to highlight the extra hours spent on more chaotic beneficiaries.

6 Engagement Phase RP - Personal Budget - Total Spend 1,856 Phase 1 - Engagement 618 Phase - Supporting Choice & Indepence 1,38 Clothes Food - Engagement Health & Wellbeing ID Other Refreshment Personal budget Spend Appendix 5 Spend on clothing included 150 for a fitted suit, Reece had an interview with a cross rail engineering company and needed to make a good impression. Reece matched the cost of the suit by buying his own shoes/waistcoat/tie Leisure and fitness spend includes a bicycle and carp fishing equipment to help maintain sobriety and good mental health and make good use of his down time. Other spend was on his occupational health assessment, this led to Reece being singed off as fit to work and there would have been no way to obtain this without access to a personal budget. Education spend has included a Laptop to complete online vocational studies and spend on course books and qualifications related to network rail employment. Travel - Day Day 11 Travel - Planned 0 Supporting Choice and Independence Accessories Education Health & Wellbeing ID Leisure - Fitness Other Travel - Day Day Travel - Planned *(Reece s real name has not been used)