Ezgi resides at a secure female unit on a Psychiatric Intensive Care Unit (PICU) and has mobility issues due to a self-inflicted injury to her leg. Ezgi’s mother was her nearest relative, but was unable to visit the ward due to her own health and mobility issues and because she lived far away.

Ezgi was referred to POhWER for advocacy support by staff on the ward. Gina, a POhWER advocate who had previously spoken with Ezgi during one of their regular drop-ins on the PICU ward was allocated Ezgi’s case. Gina attended the unit and staff informed her that they were concerned as they believed that Ezgi lacked the capacity to make decisions about medication and her personal care due to her poor mental health. Staff wanted to ensure that Ezgi had the support that she needed during meetings and her time on the ward. 

Gina met with Ezgi and reminded her of the advocacy role and remit. Ezgi told Gina that she would like her to attend her ward round meetings but was unable to instruct Gina on what concerns she wished to raise at these meetings. Ezgi instead, spoke about her day and how she felt. Gina took the Non-Instructed Advocacy approach when attending meetings on Ezgi’s behalf to ensure that the meetings maintained a person-centred approach.

Gina attended a Best Interest meeting in support of Ezgi regarding medication and personal care. Gina asked questions regarding Ezgi’s compliance with taking her medication, as staff had told her that Ezgi had begun refusing medication. Staff wanted to put Ezgi on an Intravenous (IV) drip as she was refusing to take the medication which had been prescribed to aid the healing of her self-inflicted injury which had become badly infected. Gina asked if there was a possibility of using different methods to encourage Ezgi to take her medication. Ezgi’s mother had told staff that Ezgi had a sweet tooth and staff suggested that they could try using syrup to mask the taste of the medication. It was agreed that this would be trialled instead of the IV drip. 

Gina then asked about Ezgi’s personal care. It became clear that Ezgi had stopped taking care of herself, including not showering which had likely contributed to the wound infection in her leg. Staff also explained that Ezgi could be incontinent, and so hygiene was vitally important to her wound healing. Staff discussed when to step in with showering Ezgi utilising restraints. Gina asked if Ezgi was currently uncomfortable showering due to her injury. Staff agreed this was likely, and discussed different methods to aid showering that would prevent the injury from becoming wet. Gina asked if staff could support Ezgi to give herself a sponge bath if she refused to shower due to the pain of her injury. Staff agreed they would try a number of options with Ezgi to encourage her to shower or wash herself and only if none of these were successful would they consider more restrictive options.

Gina protected Ezgi’s right to privacy, safety and dignity by encouraging the use of least restrictive practice.