General –
Title:Night Shift
LH has been nursed on 1-1 eyesight observations. He was self isolative but responded when
approached in conversation. He retired to bed at 22.30hrs and once in bed found it very difficult to
settle and took until 00.30hrs until he appeared asleep. His arms and hands were seen above his
duvet at all times. He was observed to be tapping the top of his right hand as if rythmically; as if to
music in his head but these episodes lasted no more than 2 minutes a time.
—————————–Confirmed By RClack@, 03/05/2012
Inpatient –
Title:Late Shift
Li generally appeared to be euthymic in mood. He was quiet at times; but at other times he
interacted well with staff and peers. He appeared to be anxious when the panic alarms were
triggered, and he took the opportunities to move to a quieter place when offered. He attended
groups, but was reluctant to begin with, however overall he engaged well. His social worker
called, and a meeting with him was arranged for the 9th of may at 11:00. He spent his time mainly
with his peers; either being quiet or interacting with them. He also ate well.
Li reported to be settling ‘okay’ on the ward. We discussed his interests, which included music
and computers. He reported to being an introvert, and enjoys his own space. He also reported
that he ‘wants to get out of here as quick as possible.’
—————————–Confirmed By HLee1@, 02/05/2012
Inpatient –
Li admitted as in-patient to Woodland House
– Background ADHD; on equasym
-Deliberate self harm – punching walls, trampling of hands by fellow pupils at his request
-Longstanding blood on beddings Redacted By Author “The Thing”?
self-induced and denial / avoidance of same
-nocturnal enuresis
-compulsive stealing
-hacking into computer systems
-tendency to aggression / violence
-self neglect *** personal hygiene
-physical examination and ECG were normal (declined Physical examination)
A goal of admission would be to establish / clarify diagnosis
– 1:1 observations (agreed by team)
– urine analysis / mcs (nurses informed)
– observe and monitor degree of blood loss
-admission bloods sent
– weekly urinalysis
-Ragnhild to get collateral hx form social services
-Education department to be informed of no access to computer network allowed
-staff to prompt Li re personal hygiene and physically inspect shower room as he oftebn lies about
-staff to be vigilant re compulsive stealing
—————————–Confirmed By CAkobundu@, 02/05/2012
Social Work Title: Legal issues discussed with Sarah Cannell
I asked Sarah if we should be considering an assessment for detention using the MH Act, given
that Li has expressed his wish not to be here, that he also mentioned to Dr Garrett that he had
been told he needed to come in to hospital by his community psychiatrist.
We discussed the fact that he is on a full care order, via Kent CSS, that he has been chronically
self harming, he has nightly enuresis with the complex likely picture of this being combined with
harming Redacted By Auther “The Thing”. He has a diagnosis of ADHD he has a statement from education and was
removed from his family home 6years ago along with his siblings, in a context of parental neglect
and likely abuse (not proven I believe).
Sarah’s view is that assessment under the MHAct is not indicated at this stage, given that the LA
have PR, and support the admission, that Li is probably not Gillick competant, that he is not
standing by the doors, attempting to leave, nor has he asked anyone specifically if he can go
home. It is more helpful currently to work with an informal admission as being in his best interests
currently. Obviously this will open to review, should the situation change.
We also discussed the issue of his refusal to undertake a physical examination.
given he may be causing himself infection and physical harm. Two possible approaches to
overrule his refusal are1) Specific issues order using the children act, 2) the LA to apply to the
High Court for an order for a medical examination at a DG hospital.
—————————-03 May 2012 16:12, Ragnhild Banton
Event By: Ragnhild Banton
Inpatient –
Title:Early Shift
Li has been nursed on intermittent observations this morning and is currently with the doctor who
is discussing his observation levels with him. Li’s was incontinent of urine during the night and his
bed was cleaned by the night staff. Staff report some mucus looking orange; possibly blood
droplets in and outside of his shower in his bathroom.
He has attended and joined in groups this morning but has spent most other times just wandering
and not socialising with his peers. 10 minutes after lunch I asked what he had eaten and he said
he could not remember. Li has interacted with staff and spoken about his interest in computers.
—————————–Confirmed By LKing1@, 02/05/2012
Title: Drama Group
OT Intervention: Creative Expression
Li attended drama group after encouragement from staff, agreeing to sit and watch. Once in the
group, Li participated well in all tasks, working well both individually and with peers. Li engaged
well with others, and was able to perform in front of others with encouragement. Li presented as
euthymic in mood throughout.
—————————-02 May 2012 16:52, Chloe Still
Event By: Chloe Still
Inpatient –
Dr Helen Garrett and Oliver Sindall:
Appeared slightly guarded and looked anxious. Good eye contact, age-appropriate casual
clothing and fairly free speech.
Told us at first he was in full agreement to being here. His perception is that he is here because of
his self-harm- that he got someone to stamp on his hand in school. Li said that he did not think at
the time that he needed help, but in a few meetings with Dr Nairac, he helped him to see that
what he was doing was not normal. Li said he is used to being in his bedroom at home and can’t
have his phone or computer here. He doesn’t like to be in new places either, so does not want to
be here ‘ it wasn’t my idea- I didn’t want to come in the first place’.
Issue he would want to have help with is his anger ‘that’s when I self harm’. He told us he had
approx 12 (6×2) sessions with Niall (CPN) and was able to open up ‘a little bit’. There is part of his
past that he can’t recall- he’d want to work on that. He sees his social worker Karley a few times a
month and can also talk to her ‘a bit’.
He has had suicidal thought at times, but not often. Last had them three weeks ago. They last a
couple of hours and are ‘quite strong’. He does think of methods, but no specific plans. He would
not give into them. To distract himself, he tries to be productive. eg makes websites for people
(wants to do that for work later), he does other computer activities too, such as surfing, music and
games such as ‘Sims’.
Li said he is missing talking to his friends on his phone.  tends to sit in hs bedroom and watch TV. He
denied that he is bullied.
Foster careres Carol and John. He’s been there for four years. They have grown up children
Woman-30- Man Kev – 20. There are also two other foster children -Boy- 10- and Girl- 9.
When they go out as a family, he choses to go out on his own.
He denied that he currently has an infection and agreed to give a weekly urine sample.
—————————–Confirmed By HGarrett, 03/05/2012
Social Work Title: Tel call with Karly Ratcliffe
Karly has been working with Li since Dec 2011, she told me that he has been statemented, he is
on a full care order, that he has been in long term foster care for 4 years. His current carers have
looked after him consistently for the last 3 years, it is a positive attachment and placement. The
local authority has PR, although Li has regular contact with mum, no safeguarding concerns. She
told me that Li meets his mum for a couple of hours on a Tuesday or Saturday.
Karly believes that Li is asking for help in that he wrote a note to his foster carers saying that “he
feels lost, that its dark around him, he has a problem.”
She also thinks that his anxiety about not getting help has played a part in the escalation of his
self harm, the recent injury to his hand. Karly added that he has recently come out as gay, she
wonders if this is a contributing factor also that his self harm to Redacted “The Thing” is v difficult to deal with,
Li will not tolerate any discussion around his self harm.
I asked Karly to send social work documentation relating to Li and we agreed we would maintain

—————————-02 May 2012 17:11, Ragnhild Banton
Event By: Ragnhild Banton
Title: GROUP: Lets Create
OT Intervention: Creative expression
Li was selected for group due to being recently admitted. He appeared euthymic in mood and
easy going. When offered options for projects he was able to make a decision with support about
what he wished to do. He completed a sign for his door independently using paper, pens and
stencils. Li didn’t initiate conversations but was able to respond to questions when asked. OT
talked with Li about attending the main group programme to which Li agreed to try.
—————————-02 May 2012 16:02, Laurie Guard
Event By: Laurie Guard
Title: News of the Ward Group
OT Intervention: Creative Expression
Li attended newsletter group, choosing to work on an advert for the upcoming Olympic games to
go in Oak’s newsletter. Li presented as chatty and bright in mood and worked well with staff and
—————————-02 May 2012 11:28, Chloe Still
Event By: Chloe Still
Nursing Title: Social worker Carly Radcliffe called at 09:00. Contact number is:

Phoned to check on Li’s first night at Woodlands. Stated that mum usually has unsupervised visit
with LI once a week, no safeguarding issues. Staff to call her if any queries surrounding LI.
—————————-02 May 2012 11:29, Jane Moon
Event By: Jane Moon
Nursing Title: Woke Li up at 07.25 and supported him to change his bedding. Li had a small wet patch in
front of his pyjamas, there was no indication of dampness or soiling at the back of clothing. Li
agreed ro show staff his bedding, there was a damp patch aproximately the size of a side plate
and several small patches which appeared to be blood within this area. He was able to put his
bedding and clothing into seperate red bag. Li was encouraged to have a shower, he entered the
room and ran the shower, however when he was dressed his odour suggested he had not
showered properly.
—————————-03 May 2012 00:48, Rosaleen Chapman
Event By: Rosaleen Chapman