'She'll be Back in Hospital Within Two Weeks': Using DBT Techniques to Help a Person with Comorbid Schizophrenia and Substance Abuse Return to the Community
This paper presents a case study of a person thought of by many mental health professionals as being incapable of supporting herself in the community. 'Rebecca' had been a long term user of acute mental health services, with numerous admissions over more than a decade. She saw herself as having schizophrenia and a past history of substance use. In 2005, Rebecca was referred by a specialist dual diagnosis team for psychiatric rehabiliation within an inpatient service. Given a long history of substance abuse and current positive symptoms of psychosis, little hope was held for her successful re-integration into the community. However, aspects of her history and current presentation suggested the possibility of using a dialectical behavour therapy (DBT) informed approach to engaging and working with Rebecca - especially distress tolerance, mindfulness and radical acceptance skills. Following almost six months of intensive work using DBT skills, Rebecca was discharged from hospital. She has not resumed substance use and is participating in a community rehabilitation program, supported by the local community psychiatric rehabilitation team and her individal DBT therapist from the inpatient rehabilitation service. Following a brief introduction to 'Rebecca', the presentation will describe the approach taken to engaging and working with Rebecca both during and following her hospitalisation, with particular emphasis on the integration of DBT techniques and skills within mental health nursing practice. The case study is presented with Rebecca's permission and personal indentifying information has been changed to protect her anonymity.