Case Study – Mental Health

case studies

Case Study – Mental Health

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A selection of more unusual case studies SAS-fit has managed for their clients

Mental HealthThe following are examples of the wide variety of cases referred to SAS-fit. Each has been compiled using real information and symptoms seen by our network of therapists. To adhere to our own guidelines concerning confidentiality, some incidents have been amended to avoid any potential compromise and confidentiality, but all of the information and symptoms are genuine.

Case Study 1:

A 33-year old employee was referred following a lengthy absence and a history of multiple absences over the period of the last 3-years.

Three years previously, the employee was involved in a particularly traumatic incident at work. He was unable to return to his original post as he was suffering from depression following the incident and was transferred into alternative employment in a different department. Although this change had occurred, the absences continued.

He advised that his depression had grown worse over time and had started to impact on his marriage and his relationship with his children.

The employee was then involved in another incident where he arrived at work to find that his office had been broken into and ransacked. He was sent home suffering from stress in addition to his depression. The employee had considered suicide and had made definite and detailed plans to end his life. He did advise his therapist that a phone call, from his child’s school had prevented his death.

A highly trained therapist used our own, unique Functional Integrated Therapy (F.I.T) to identify the root cause of the problem and enable the employee to manage his condition for himself.

The employee returned to work two days after the treatment and had only three days of absence in the following 12 months, caused by a dose of food poisoning following a meal in a local restaurant. This in comparison to an average of 16 weeks per annum in the three years between the initial incident and the date of his referral and treatment.

Due to the nature of the referral, a follow-up session was offered a week later. This was to assess the employee’s reaction to the initial treatment and to further embed the coping strategies and relaxation techniques. The employee presented in a much more positive frame of mind and advised the therapist that his whole life had been changed and that he could not believe that one session could have such a dramatic effect on his wellbeing, this was further confirmed a few weeks later by his G.P who had reduced his anti-depressants and blood pressure medication. This second treatment session was used to challenge the employee and to ensure that his symptoms had been addressed with no residual problems.

Case Study 2:

A 50-year old employee was referred following an incident at work where a person had committed suicide by throwing themselves in front of his vehicle. The employee had been absent from work for a period of 6 weeks since the incident. During consultation, it was identified that although this incident had affected his mental state, he saw this as ‘the straw that broke the camel’s back’ and advised that he had, in fact, been affected by the death of his Mother seven-months previous and he had still not come to terms with this loss.

The employee also advised that he had been absent from work for a 7-month period the previous year due to a shoulder complaint, which was not connected in any way to the presenting condition, but he was still experiencing painful symptoms.
Our therapist addressed the effects of the loss of his Mother before focussing on the trauma due to the incident. This removed the root cause of his presenting condition, alleviating his anxieties, allowing him to cope in a more positive manner within his work environment, and his personal life.
Having advised of a physiological complaint, a physiological therapist treated his shoulder.
On presentation for his second appointment, feedback from the employee was that his shoulder was improving and he was feeling positive about full recovery. He advised that he had returned to work in a full capacity, following a consultation with his OHS doctor, and continued to use his exercises when necessary.

Case Study 3:

A 45-year old Female employee was referred with symptoms described as stress related irritable bowel syndrome (IBS). Her condition resulted in regular absence from work over the last two years as, during stressful periods at work and at home, she experienced severe stomach cramps and an urgent need to use the bathroom. During consultation, it was established that the underlying causes were actually due to domestic violence within the home and she felt that she could not discuss this with her line manager or attend work when she had bruising or other injuries which were visible.

Treatment was based around increasing levels of self-esteem and confidence.

Advice was given by the Therapist, regarding discussing the issues with her family and her employer. The employee was also given nutritional advice to assist in the management of the symptoms of IBS and details of her local Domestic Violence WPC contact number and local family therapy/relate counselling service.

Further treatment sessions were offered to the employee if she felt that she needed support or reinforcement of the exercises given. Having returned to work two days post treatment, the employee returned for a second treatment session, four weeks after the first.

She presented in a positive frame of mind and advised that her IBS symptoms had improved significantly and that she had spoken to her husband following the first session advising that she would involve the Police if further episodes of violence occurred, they are undergoing counselling together and her partner is attending a course of anger management of his own volition and dealing with his own underlying issues.

The employer has since advised us that the employee has recorded no absences since the initial treatment by SAS-fit.

Case Study 4:

A 49-year old experienced train driver presented having been involved in an incident where a person committed suicide by jumping out in front of the train he was driving.

Consultation revealed that he had been absent from work for three-weeks and the incident was affecting his relationship with his family. He also advised that he had not been able to drive his car or board a train since the incident. As a result, we arranged treatment in his home town, to avoid any potential stress caused by travelling.

During consultation, the employee described experiencing ‘Flashbacks’ to the incident and also advised that he had been involved in incidents of this nature previously but had not been affected. On the occasion of the incident, the employee was assessing a driver who was in training to become a train driver. The employee’s line manager was also present in the cab, assessing the assessor. In the aftermath of the incident, the employee was the first on the scene where the body was left following the collision.

The employee was moderately aggressive at the time of the first consultation, which is not uncommon.  Physically, the male had been experiencing severe headaches following the incident.

The employee was not happy with the approach offered by a psychological therapist, where the use of relaxation techniques and guided imagery would have been used. As a result, the therapist adopted a more traditional counselling approach, but used some modern therapies to allow the employee to come to terms with his thoughts and feelings since the incident. Following the first treatment, the therapist gave the employee some simple self-help exercises for him to complete on a daily basis with his wife.

By the time of the second appointment, the employee had made significant improvements in his demeanour and was no longer aggressive. He had returned to driving his car and had travelled to an appointment by train. After a series of four treatment sessions, the employee advised that he was ready to resume work and was advised to contact his line manager to arrange a resumption medical so that he could return to full duties as soon as possible.

Feedback from the employee advised that the therapist had ‘fixed me’.

As the employee had advised that he was experiencing headaches following the incident, we arranged for an appointment with a physiological therapist. The employee had three separate treatments to relieve muscular tension to his neck and spine. He advised, following the first treatment, that he had not had a headache in the week between his appointments, but it was advantageous to offer two further treatments to ensure a full recovery.

Case Study 5:

A 35yr old finance clerk presented following a prolonged history of absence after an incident involving another member of the small team in which she worked. Her employers felt that they had reached an impasse in the situation as they felt that they had done everything reasonably practicable to assist in her rehabilitation. They felt that they needed a successful conclusion to the matter whether this resulted in a return to full employment or mutual termination of her contract. During consultation, the employee advised that she was currently absent from work having been diagnosed with stress and anxiety. She advised that she felt that she had not been afforded suitable support by her employers, especially her line manager.  As a result of this perception, there was some venom present aimed at her colleague and her line manager. The employee advised that she had undergone several counselling and Cognitive Behavioural Therapy (CBT) sessions, prior to her referral to SAS, but did not feel any benefit. However, she was happy to engage with our therapist and was keen to reach a conclusion in so that she could move on with her life. Initially, her treatment involved the use of Functional Integrated therapy modalities and some self-help exercises to be completed at home.

On presentation for her second appointment, the employee appeared more relaxed and calmer, in direct comparison to the obvious anxiousness, shaking and tearfulness of the first session. She advised that the exercises had helped her sleep better and she was subsequently feeling more rational and positive. She advised that her family and close friends had all noticed a significant difference in her general demeanour, which surprised her after a single treatment session.

Her treatment continued with a more in-depth session giving her coping strategies and exercises around letting go of the past and moving her life forward. At the end of the session she felt that she had cleared all past issues regarding her colleague and line manager and could feel the shift in the way she viewed these issues.

She agreed to continue with new exercises provided to reinforce the changes, build confidence and aid her decision making. She advised that she had started to see a new direction for her life and was considering her options.

On presentation for the 3rd session the employee advised that she now considered her initial plan, to prolong her absence until she reached six-months, to be unacceptable and was in high spirits having made her decision to leave the company. She had already been in touch with her HR department to facilitate an ‘early exit, with dignity’ and her employer had agreed to assist her in this matter.

Case Study 6:

A 34-year old male employee was referred following several periods of absence due to depression over the previous 2 years. He has been drinking excessively to ‘numb his mind’ and has been prescribed anti-depressant medication, by his GP, which he feels is assisting with his low mood. The employee feels lonely and misunderstood by his wife, his family, colleagues and his employers. He feels like ‘he doesn’t fit in anywhere’.  His Dad died when he was 2-years old so he never knew him; however, he recently contacted his Dad’s side of the family and feels an affinity with them, citing that they had all ‘done well for themselves’, as opposed to his own family who, he felt, had not.  Since the birth of his son 2 years ago he has pondered on his poor upbringing (alcoholic mother, various step-fathers) and wants to be a more positive influence on his son. He feels his mother is a negative influence in her language and behaviour around his son but, because they need her to mind the child on occasion, he feels powerless and worries when his son is with his Mum.

The employee has problems sleeping and feels alcohol helps. He has marital problems and feels that they do not communicate at all except when they are shouting at each other. He feels that when he is stressed his facial tics become intolerable and this makes him not want to be with people; again, he feels alcohol alleviates this problem.

During his first treatment session, the employee agreed to some self-help exercises to aid sleep, and our therapist asked the employee to encourage his wife to participate in the exercises, to encourage communication in an effort to improve their relationship.

On presentation for his second session the employee was visibly in higher spirits and had not used alcohol to help him sleep during the past week. He is taking positive steps towards total abstinence from alcohol and finding the exercises are helping him. The joint exercises between him and his wife have improved the marital situation and discussion between them has led to positive changes and agreement on a way forward.  We focussed the third session on his facial tics and he was very pleased with the outcome.

He continued with the alcohol withdrawal exercises and agreed to a session to help him to stop drinking alcohol altogether. This was delivered in his fourth treatment session and was successful.

He is now abstinent from Alcohol and withdrawing from the prescribed anti-depressants with his GP’s help. He feels has the necessary coping strategies in place to deal with this detoxification.  The employee took 3-weeks to fully withdraw from the prescribed medication and is back at work and coping well.

Case Study 7:

A 39-year old Senior Manager was referred by his line manager following disclosure that he had become reliant on Cocaine.  The employee had approached his GP regarding a concern that the use of this recreational drug had become his coping strategy to assist him when he was feeling stressed or anxious. He did not want his use to escalate and affect his work performance.

His GP had arranged an appointment for Psychological evaluation, but test results showed that although the drug use was present, the employee was able to function normally and perform his working role to a high standard. As a result, he did not fit a Psychological profile that indicated that assistance was needed or available to him.

He was subsequently referred to the Drug and Alcohol team, which was a service provided by his Local Authority. Their assessment showed that he was a part-time user, was not addicted to the drug and in the case of cocaine, they could not offer assistance as they were unable to offer a more suitable alternative (such as Methadone for users of Heroin).

Further investigation revealed that the employee had a number of issues which were triggers for his stress and anxiety. Once these were identified, our therapist was able to address the underlying causes and provided coping strategies, Functional Integrated Therapy (F.I.T) and self-help exercises to remove the reliance on the drugs.  To further assist with the issue, our therapist used a number of Psychological treatment methods (all within the first appointment), to remove the use of the drugs as an option.

The therapist concluded the session by advising the employee to contact her if any further assistance was necessary.

This employee has never exercised the option to attend any further appointments. His employer has advised us that they have seen a significant change in the employee’s demeanour and work ethic.

Case Study 8:

A delivery driver presented with anxiety while driving. He stated that he had not been involved in any incidents but described an occasion when, through lack of sleep, he had been drinking Red Bull to stay alert. This increased his awareness to a level where sudden noises or bright lights made him jump and he became anxious. His symptoms increased until he had a panic attack and was sweating and shaking. Because he couldn’t think straight, he stopped driving until the symptoms passed. Once he reached home at the end of his shift, he felt calm and relaxed. Although he has not consumed Red Bull ever since, he still experiences occasions where a noise, or certain lights would trigger another panic attack and he was starting to ‘Panic about Panicking’.

An SAS therapist used a suite of therapies to induce relaxation and to identify the source of his anxiety. The Driver remembered being at home, watching a late-night programme on TV. It showed fire-fighters trapped in a building during the 911 terrorist attack. They were trapped amongst twisted metal and lights were flashing. They were shouting to each other as the building collapsed on them. Although the driver was relaxed, he felt anxious as he ‘stepped into the shoes of the fire-fighters’ and, as the footage continued, there were images of a Lorry crashing and being blown over onto cars with people inside, then a train crashing. Throughout the images, there were flashing lights that created a link between raised anxiety and the drivers own mortality. He had an emotional attachment to the footage and the symptoms re-occurred whenever he saw flashing lights or found himself in certain situations.

Treatment reduced the driver’s anxiety and removed the emotional attachment to the events described. His reactions to images and lights were tested as part of his treatment plan and showed that the link had been broken, allowing the driver to return to work with the confidence that his symptoms would not return. He was given some self-help exercises to reinforce the changes in his behaviour and to use in the future, should any of his symptoms re-appear.


This selection of case studies shows the variety of referrals we accept from our existing clients. In addition to these unusual cases, SAS-fit assist in the management of any physiological or mental health absences. As you can see from these cases, on many occasions, the root-cause of the employee’s condition, symptoms and absence is not always what it is perceived to be. In many cases, this is only identified because our service is confidential and employees are happy to divulge information to our therapists that has not been disclosed to their line manager.

SAS-fit treat the person, their life-story, their symptoms and how they are affected, rather than accept a diagnosis that is simply a label, given by the NHS as a precursor to a one-size-fits-all treatment plan.


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