Case study – Matthew (15 years old)

Matthew is 15 and not in employment, education or training. He has been admitted to the paediatrics ward after falling from a building while drunk. He lost contact with his drug and alcohol counsellor when the youth clinic closed.

matthewMatthew is a 15 year old male and a regular user of drugs and alcohol. He often shows up at the hospital emergency department, heavily intoxicated and sometimes with physical injuries sustained from fighting, and injuries caused by him blacking out. This time, Matthew fell from a building, shattering his ankle. He had been smoking synthetic cannabis with his friends. Surgical plates and screws have been inserted in his foot, and he is confined to bed rest until he is well enough to begin physical therapy and rehabilitation. 

Matthew was admitted to the paediatrics ward, as all inpatients under sixteen are admitted to paediatrics. When Matthew has been in hospital in the past, he had been difficult to manage, and has frequent outbursts of abusive language and aggression, which does not create a good environment for younger patients. Matthew’s injuries mean he cannot leave his bed easily, causing him to become frustrated and to be seen as a challenging patient. After previous incidents, it would have been more appropriate for Matthew to be in an adult ward, but orthopaedics is full, with overflow already being managed by the general medical wards. 

Matthew has been stood down from school for violence and having drugs on him. He is disengaged from school and is truant regularly. When he began secondary school, his reading age was assessed as being at around that of a nine year-old – well below the average for his age group. A ​Dean at Matthew’s school referred him to a drug and alcohol counsellor at a local youth clinic, who he met with regularly. The youth clinic was unable to secure operational funding and was forced to close. While clients were able to transfer to a clinic in the next town, Matthew’s counsellor would not be on staff. 

Matthew's story
'Hospital again. In the kid’s ward too, even though I’m nearly 16. Little kids cry in the night. I want a smoke, but they put bits of metal in my ankle and I can’t leave the bed. Usually I just go to Emergency, the doctors give me a cup to throw up in while I sober up. A couple of times my mates dropped me off at the door and I had already coma’ed out. I don’t know what I had smoked, but my mate said it was synthetic weed. I smoke that heaps. Sometimes I get stitches or bandages, because when I go around with my mates, we might get in a fight with some other guys. 

I got stood down at school for fighting and having drugs at school a couple of times and mum was pretty mad. I hated school anyway, so when I had to go back I started wagging a bit more and then I just stopped going. Mum stopped asking about school – she’s asleep or working late shift so we don’t talk much. Sometimes I do some labouring if my mate’s uncle can get us a job, but that hasn’t happened for a while. 

When I got stood down the first time, the Dean and the guidance counsellor at school told me about this drop-in youth clinic in town. I didn’t want to go, but the Dean knew one of the doctors there and said he might be able to help me – the counsellors said I’ve got “anger issues”. I just get stressed out with people always on at me. The doctor was okay, and he took me to meet this drug and alcohol counsellor. We didn’t talk about drinking or smoking pot or anything at first – he wanted to know about my family and school, what my mates were like. Sometimes I didn’t go to the appointments because I was wasted, or I forgot, but when I did go I liked talking to him – I felt like he listened to me. I was real sad when he said that the youth clinic was going to close because there was no more money for it. There is another clinic about an hour away I could go to, but he won’t be working there.  

So now I’m in hospital again with screws in my foot because I broke it too many times. I’m tall, and everything is made to fit little kids so I feel out of place. They had to bring a bed for me from a different part of the hospital – it took ages and I got angry because my foot hurt, and I wanted a smoke. The doctors and nurses say they are trying to get me a place in a different part of the hospital, but there is no room.'
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