Gemma is 24. She has a diagnosis of depression and anorexia. She experiences overwhelming emotions and mood swings. She sometimes self-harms and does unsafe things like binge drinking.  

Gemma suffered childhood sexual abuse and she has some physical health problems. She has a poor appetite and poor sleep. She goes to a community group which she finds helpful. Gemma is also experiencing domestic violence and has been assaulted by her partner. 

Treatment in the past 

After Gemma’s GP referred her, she was supported by a community mental health nurse. She saw a non-medical prescriber (a nurse who is qualified to prescribe medication). She was prescribed anti-depressants and Zopiclone to help her sleep.  

After this treatment, Gemma was discharged from the mental health team, but her moods soon became unstable again. She was not eating enough and had begun binge drinking and self-harming. A family member then died. After this, Gemma was drinking every day, and needed an ambulance after she overdosed on medication and alcohol. At the same time, she felt she was being pushed out of her community support group.  

Gemma needed mental health support as her symptoms were becoming more difficult to manage. She had flashbacks of her past trauma, and the domestic violence in her relationship was still going on. 

Treatment now  

To make progress, Gemma needs a clear treatment pathway with goals and an end point. She also needs the right specialist help.  

Gemma contacts the ACCESS team who complete an assessment. They feel Gemma’s needs would be best met by a treatment pathway called Enhanced Intensive Life Skills. This will help Gemma learn skills and strategies to manage her symptoms and meet the goals she sets. For example, she will learn ways to understand healthy relationships, helping her to build a more supportive social circle. 

Gemma is given a mental health worker from the team, who will coordinate her care. She has a peer support worker, who has had similar mental health difficulties and uses her experiences and empathy to support others.  

Gemma and the team work out the goals she would like to meet to manage her symptoms. They explore which specialist services could help her meet her goals. 

Gemma agrees to see all the services suggested by the team. 

With support from Staffordshire Treatment and Recovery Service (STARS), Gemma begins to drink less alcohol. She uses her new skills to control her urges to drink and do other risky things. 

Gemma gets support from New Era, a service that helps anyone affected by domestic abuse in Staffordshire and Stoke-on-Trent. Gemma begins to recognise her self-worth and takes steps to leave her violent partner.  

Input from the Eating Disorder service helps Gemma stay at a healthy weight. She now has skills to help her keep eating well. 

She is supported to stay in her community support group. She also starts volunteering at a local animal shelter, which she really enjoys.  

Although Gemma is getting help from several services, she is not being moved from one to another, which could cause delays and gaps in her care. Instead, they support her at the same time and in a coordinated way. Gemma and her named workers from each service regularly meet to update her care plan and review her goals. She is always involved in the planning. 

View Gemma’s Pathway