These case studies illustrate the types of challenges presented to Syrona and briefly describe how our services might operate to bring about a solution. Each case study is a collection of features from different clients rather than the same case to avoid distress and protect anonymity.
The personal assistant of a client with bipolar disorder, a successful businessman from an influential family, contacted Syrona. He was in a private hospital following an acute episode of mania. He remained unwell and heavily sedated. Yet, there were signs that he was improving and would soon no longer require hospitalisation.
A briefing was held between Syrona and hospital staff. The client underwent a virtual assessment. He was a private man. His preference was to leave hospital as soon as he was manageable in a home setting. Historically, he also suffered severe depression for months following significant manic episodes. The client opted for treatment initially in the Cotswold. He was fond of the UK and the outdoors.
A Syrona nurse accompanied him to the UK once hospital discharge was agreed. The team organised a full episode of care in an idyllic countryside setting. He wanted to be sheltered from a hectic lifestyle whilst he recovered. A clinical and wellbeing programme was devised with the client, partly delivered by live-in staff, partly by visiting specialists. Medication was reviewed and changed. Therapy commenced to address his symptoms, experience and consequences of illness on his life, family, work and relationship. His long-term partner, who travelled with him, joined in some of the relevant sessions.
With better adherence to medication and support in a structured programme of activities, the client noticed that the pace of recovery was comfortable. His nutrition improved on the recommended food plan. He built up his physical stamina with a physical reconditioning programme. He appreciated the combination of wellbeing activities such as yoga, pilates and breathology. Biological markers of physical health also improved, such as lean body mass.
The client opted to move from the UK to his fully staffed yacht. The live-in team comprised of a specialist nurse and therapist. They continued to support and work with him to pace his recovery. Increasingly he was able to work remotely on his numerous businesses. He was eventually discharged back to his local psychiatrist, who had been kept in the loop to ensure a smooth transfer of clinical care at the end of treatment with Syrona.
A client contacted Syrona via her psychiatrist. She had developed a problem with benzodiazepine addiction. Her psychiatrist had tried a reduction of benzodiazepines over many months without success, including in private hospital. The client did not wish to be treated in hospital again. She was from a well-known family, who agreed to a discreet solution.
In addition to detoxing patients from all regular substances, Syrona has developed protocols for the rapid withdrawal from benzodiazepines over 10-14 days using continuous subcutaneous infusions rather than the 4-6 months it can normally take by other methods. A brief discussion was arranged between Syrona, the consultant psychiatrist and his client. Initial care plans were agreed prior to her departure.
The client flew privately to Malaga Airport with her psychiatrist where she was met by her personal attendant and taken to a well-appointed villa. She was introduced to the all-female clinical team living in with her. Some of her food and activity preferences were discussed. She was tense about treatment. She agreed to have a massage and had dinner, settling to watch a film with her clinical companion. The following day, more confident and rested, she had a series of physical tests in the local private hospital. The results came back that evening and her detox regime started.
Over a period of 14 days, live-in staff reviewed her physical and psychological health, monitored infusion sites, dispensed additional medication and provided emotional support. She was seen by her Syrona psychiatrist twice per week. Clients can mobilise well with the infusions. The withdrawal effects were well-managed. The client was able to participate in a range of activities including shopping and dining out. She visited a number of places of personal interest, such as the Mosque in Cordoba and Alhambra in Granada. She was accompanied by a warm and supportive female companion.
The client stated that she was also looking to lose weight. She followed a wellbeing programme determined by the nutritionist working with the chef, and the personal trainer. This included a food plan, graded exercise adapted to her capabilities to improve her physical strength, yoga and massages.
In the second week she discussed how anxiety was associated with her addiction. Her local psychiatrist visited her once more in Marbella. Her consultant psychiatrists liaised with each other, medication was reviewed and she agreed to start individual therapy. After a successful detox, the client decided to stay for a few more weeks to address psychological issues, enjoying the comfort of a home environment and the company of the team. She eventually returned home with the Syrona therapist who worked with the client’s psychiatrist to oversee her ongoing treatment.
The family of a 15-year girl was contacted by her school abroad. She was losing weight quickly after developing an eating disorder. The school’s psychologist was not able to cope with the client’s health and behaviour. The family contacted Syrona after a personal recommendation. Following an assessment by a child and adolescent psychiatrist, the family and the client were presented with a number of options. They agreed to a period of stabilisation at home before considering residential rehabilitation.
Syrona developed care plans to support the client and the family at home. 2 nurses and a therapist were identified to live in. They formed a rapport and helped contain the level of disturbance displayed by the client during periods of increased agitation. The dietician saw the client remotely and worked with the family chef to formulate a food plan. The psychiatrist held professional meetings with the on-site team to review care plans weekly and flew in to visit the client fortnightly.
Over 8 weeks, the client’s weight stabilised and she was more able to engage therapeutically. The family accepted our recommendation for the client to attend a specialist residential service for 12 weeks to address issues within a therapeutic community. Upon discharge from residential care, Syrona became involved once more to consolidate her progress with the therapist and help organise gainful activities.
A client was referred to Syrona by his family office. He suffered opiate addiction and alcohol misuse. Treatment in residential rehabilitation centres around the world were followed by quick relapses after leaving restricted environments. The client’s addiction severely disrupted his social, family and vocational functioning. The family wanted to assess whether he could achieve a period of stability and recovery to have a minor role in the family business. Failing that they wanted a long-term plan for his ongoing care and recovery journey.
The client underwent a full psychiatric and specialist nurse assessment by Syrona to determine the best treatment option. A strategy using harm-minimisation with oral opiate maintenance treatment was jointly chosen. The client opted initially to move into rented accommodation in London. The family supported his decision.
A Syrona live-in team comprised of 2 specialist nurses supported the client during an initial mild alcohol detox and stabilisation on oral opiate maintenance. After stabilisation, the nurses were replaced by a sober coach living in. The client was seen 3 times weekly by an addictions therapist. He also decided to participate in a wellbeing programme, which included personal training and a nutritionist formulating a food plan.
Over a period of 6 months, it became clear that the client was not ready to engage in the family business. Syrona developed an educational and mentoring programme. Live-in support was no longer felt necessary. He continued to see his sober coach and therapist several times per week, building his problem-solving and decision-making abilities, which had been impaired after years of drug abuse. He was discharged after a year to continue maintenance medical treatment with his psychiatrist back home.
The client contacted Syrona 3 years later. He was well and integrated, albeit within his capabilities, in the family business. Seeking abstinence, he reduced doses of maintenance medication. However, he was finding the last reductions difficult due to withdrawal effects. He felt a little burnt out. He was concerned about the risk of relapse. Syrona commenced a medical detox, which lasted 4 weeks. On this occasion, the client also opted for the warmer Mediterranean climate and to undertake an intense wellbeing programme to de-stress and gain fitness.
The family of a male client found Syrona on an internet search. The client was suffering severe depression. He was unable to perform daily tasks or structured activities, and spent most of the time in his room. His appetite was poor and he was losing weight. He had become convinced that there was no prospect of recovery. He had thoughts of ending his life. The demands of looking after him were increasing and the family was worried. The client had required hospitalisation for a year in a previous episode, which had been a negative experience. His family were keen to explore alternatives to hospital treatment.
Our Consultant Psychiatrist travelled to Switzerland where the client was residing. Two other members of the team participated in the assessment, who then stayed on in Switzerland. They supported the client and relieved the family from fulltime care. Syrona prepared the rest of the 24-hour live-in team in one of the family homes in Southern Spain. Staff flew with the client once the clinical and domestic services were in place in Marbella. The client’s sister accompanied him initially.
Clinical care plans for each area of need were established. Medication was supervised, his mental state monitored, physical health and response to medication reviewed. A member of the team was allocated to engage and observe him round the clock given the risk of harm to self, until this risk reduced. Initially, intense therapy was not possible due to his poor concentration and depressed mental state. Yet, the therapist and client were able to start establishing a working relationship. They addressed symptoms and consequences of his illness. A wellbeing programme was developed by the nutritionist in collaboration with a specialist physiotherapist experienced in physical reconditioning of individuals suffering mental disorder.
As the client responded to treatment, the team worked with the client to develop a programme of structured activities. Trips to beaches and internal lakes were organised. He went on increasingly longer hiking and cycling outings. He re-established his love of painting. Therapy started to address longstanding issues that arose during his early development. He was joined by his family and girlfriend for several weeks during the various stages of his treatment. The team took the opportunity to hold joint psychoeducational sessions and address factors relevant to the client through family therapy sessions.
After a 6 weeks he tired of Marbella. The team and family organised his move back to his home in Russia. He was accompanied by his companion and therapist, as he remained depressed, and it remained important to help him pace his recovery. The live-in team remained in place for a further 2 months. They accompanied the client on an international trip to support his recovery. The family and client were delighted with the low levels of disruption and discrete nature of the live-in part of the treatment episode. The client remained under the care of Syrona on an outpatient basis for a further year, and was followed up by a combination of face to face and virtual sessions.
The family of a woman with a recurring psychotic disorder contacted Syrona. The client was in a private psychiatric hospital in France, where she worked, after suffering a psychotic episode. Everyone realised that she remained unwell. The family were concerned that the client would leave hospital, stop her medication and become very ill again. They wanted a service that could continue her treatment when she left hospital.
Syrona staff assessed the client in hospital. The hospital team agreed to test whether the client was able to manage increasing periods of time in a home setting. The client agreed care plans focusing on what would help to keep her out of hospital and she was discharged. Two nurses and a life coach were allocated to support the client. She flew with staff to a fully staffed and exclusive villa in Southern Spain. Her mother accompanied her.
Syrona’s specialist mental health staff provided live-in care in Marbella. Her medication and response were monitored regularly by the consultant psychiatrist. The client remained unwell with low levels of motivation and appearing detached. Trips to various locations were arranged daily to structure her time and help with her recovery. The client’s mother noted that staff were professional, caring and discreet. She was grateful for psychoeducation regarding her daughter’s condition. The client felt involved in her care and her experience of treatment was positive.
The client moved back to France after 2 months. The Syrona psychiatrist liaised with the client’s psychiatrist in France to hand over medical responsibility. A member of the Syrona team continued to provide live-in support and to help structure her time with gainful activities, such as weekend trips, cinema and gentle walks. Live-in support was reduced to home visits after 6 months. Syrona staff visited the client at home and stayed locally in accommodation owned by the family, who had returned to Africa. As she regained her independence, she was discharged by Syrona back to the care of her psychiatrist in France.
