NCM is a young woman with a complex presentation, including emotional dysregulation, vulnerability, and fluctuating capacity across different areas of her life. Historically, she has experienced periods of significant distress, which have led to behaviours such as head banging, verbal and physical aggression, and difficulties maintaining safe daily routines without support.

When NCM first moved into Bishops Farm, there were considerable concerns around her safety, emotional well-being, and ability to engage in a stable routine. While a Best Interest Decision confirmed that she had capacity to consent to her placement when supported appropriately, it was clear that she required consistent structure, clear communication, and person-centred support to maintain this.

In response to this, a consistent and structured support approach was implemented. Staffing levels were increased to ensure both physical safety and emotional containment, with two staff supporting her at all times within the home and three staff supporting her in the community. This has enabled proactive support, particularly during early signs of distress, and has helped to manage risks without escalation wherever possible. A “change of face” approach was also introduced, which has proven effective in reducing heightened emotional responses.

Support is underpinned by a clear Positive Behaviour Support plan, with a strong focus on early intervention. Staff have become skilled in recognising subtle changes in NCM’s presentation and responding with distraction, redirection, and reassurance before behaviours escalate. Physical intervention is only ever used as a last resort and always in a proportionate and least restrictive way.

Environmental adaptations were also necessary to reduce risk. Items that could be used for self-harm are secured, and access to certain toiletries is monitored due to previous misuse. This has helped to create a safe and predictable environment, with clear and consistent boundaries that reduce anxiety for NCM.

With guidance from Clinical Psychologist, Pippa Humphries, this approach has been gently developed to support positive risk-taking. A personalised plan was created with NCM, ensuring she felt involved and listened to throughout. As part of this, she is now able to access certain items when she is in her “green” stage of the PBS plan, when she is feeling more settled and able to manage risk safely. During a CPA meeting, Pippa complimented Acorns team commenting “NCM’s mental health has been the best I have seen, in the last four years”.

This has been an important step in helping NCM feel more in control of her day-to-day life. It has supported a greater sense of independence while still maintaining the safeguards needed to keep her safe.

Medication continues to be managed closely by staff, with secure storage and supervision during administration to reduce risks of concealment. Over time, staff have developed a more relational and supportive approach, offering reassurance and emotional support, which has helped improve engagement and trust.

Access to the community continues but is carefully planned and risk assessed. NCM is supported by three staff members and uses a personal vehicle to reduce environmental stress. Her tolerance levels are closely monitored to ensure activities remain positive and do not lead to overstimulation.

A key turning point in her progress has been the strength of multi-agency working. The service works closely with clinical teams to ensure that guidance is not only followed but meaningfully embedded into day-to-day support. This consistency across professionals has created a more stable and predictable experience for NCM. The home has also worked closely with NCM’s GP surgery to ensure she has timely access to support, when required to support her overall wellbeing.

This progress report highlights the importance of consistency, proactive support, and strong multi-agency working when supporting individuals with complex needs. It demonstrates that with the right structure, skilled staff, and a person-centred approach, meaningful and sustained improvements in mental health and wellbeing are achievable.

NCM’s support is reflective of PBS lead recommendations, with a clear focus on positive risk-taking rather than restrictive approaches. This recognises that her behaviours of concern are primarily driven by emotional dysregulation and vulnerability, and are best supported through empowerment, choice, and safe opportunities for independence. In line with clinical guidance, the service continues to promote access to meaningful activity, personalised environments, and jointly agreed strategies that allow NCM to take safe, supported risks. This approach has strengthened engagement, reduced distress, and built greater trust in staff, demonstrating a more settled and stable presentation over time. NCM has made clear and sustained progress, with improved emotional regulation, increased confidence, and greater independence in day-to-day life, reflecting a meaningful and positive impact on her overall wellbeing and quality of life.