Practitioner: Mark Sloman
Field: Social worker, community mental health team
Location: Wells, Somerset
Client: Heather Johnson, a 41-year-old white British woman, has a history of significant mental health problems and has learning difficulties. Her weight – at the time 22 stone – also presented physical difficulties.
Case history: For many years, Heather experienced psychosis for which she had been an in-patient for about four years in a large hospital. After this she had been unengaged with services for some time. In July 2001, Heather’s GP referred her case to the community mental health team. Sloman and a nurse colleague visited Heather to carry out a comprehensive social and health care assessment and found her social and environmental situation “pretty inadequate”. Following a spell in hospital, Heather’s supported lodging tenancy was terminated and she moved in temporarily with her sister, Jackie and Jackie’s husband, Bryan Bevan. There had been in the past a level of physical and sexual abuse in the family.
Dilemma: Although it appeared that her brother-in-law was financially abusing Heather, she was loyal towards them as they were the only family with whom she had contact.
Risk factor: By having Heather maintain links with the Bevans, they could exploit her loyalty and trusting nature and continue to financially abuse her.
Outcome: Heather has agreed to a police investigation of the alleged financial abuse.
For those social workers who stray into territories outside of their immediate knowledge, having an easy-to-follow, explicit procedure can make all the difference. This was the case for mental health social worker Mark Sloman in his involvement with Heather Johnson, when the vulnerable adults policy helped focus his work.
Heather was living temporarily with her sister and brother-in-law Jackie and Bryan Bevan. “She was difficult to cope with. She was incontinent and some of her behaviour was quite risky. For example, she dropped cigarettes and because of her size was unable to pick them up again,” he says. However, Sloman also had a feeling – “but nothing more” – that something wasn’t right with her relationship with her brother-in-law.
Following admission with chronic respiratory difficulties, Heather spent three months in hospital. Bryan, although acting as Heather’s advocate, proved difficult to get in touch with and failed to attend meetings. “We found a specialist residential unit that could meet Heather’s range of needs and manage her behaviour. Heather knew the place – having been there previously on respite stays,” says Sloman.
Before she could move in, there had to be a financial assessment. “Heather was insistent that Bryan should control her finances. She trusted him. Although I felt uneasy about this, she was an adult, she had mental capacity and was able to make that decision. So although Bryan lived about 30 miles away from Heather, he became her financial appointee,” says Sloman.
With the exception of her personal allowance of £16.80, Heather’s income should be paid towards her care fees. But Bryan was drawing all her benefits and passing nothing on. “When I did manage to speak to Bryan, he would just say, ‘yeah, yeah, it’s on its way’. But as the home was not receiving the full amount and was even subsidising Heather’s weekly allowance, I arranged for the council to pay the full amount, pending repayment from Bryan,” says Sloman.
Having exhausted all avenues to recoup the money, Sloman informed the Benefits Agency who froze Heather’s benefits. Similarly unable to get in touch with Bryan, it placed the case with its legal section.
“All along I was trying to manage this difficult situation and support Heather as best I could,” says Sloman. “She was hugely vulnerable and open to exploitation. On one hand she was really loyal to the Bevans, but she also knew that they were basically ripping her off. This all made her feel confused and angry.”
Things then took a disturbing turn. “She received a letter from a building society saying, ‘Thank you for your letter asking us to withdraw £3,000 to be made out to Bryan Bevan.’ Heather was hysterical,” says Sloman.
At this point Sloman reached for the multi-agency adult protection procedure. “This was very helpful as it was very clear around the issues of financial abuse. I felt strongly that this was what was happening – Heather was being exploited financially. The whole situation was having a detrimental impact on her welfare, hindering her progress,” he says.
Sloman and his manager called a strategy meeting in line with the policy. There were representatives from all those involved, including police, care home, and finance department.
“We put all the evidence together and drew up a plan,” he says. “This included continuing to work with the Benefits Agency around ensuring payments got to Heather; thinking about how we were to investigate Bryan and the impact that that might have on Heather. There was a concern that if Bryan began to feel the heat he would put more pressure on Heather.”
It was agreed for Sloman to explain to Heather that money owed [now £5,000] to her had gone missing. “I did that with a police colleague present and in a way that wasn’t accusatory. Heather agreed that we could look into it – and she gave a statement to police, who are now investigating.”
The relationship between Heather and the Bevans has, according to Sloman, become “volatile”. They visit less often and sometimes Heather doesn’t want to see them. She is happy in her new home, has new friends, is no longer so overweight and is beginning to feel good about herself.
Arguments for risk
- Although Heather was fiercely loyal to the Bevans who were the only family who wanted anything to do with her, she was also aware that they were exploiting her. This was causing her great stress, confusion and anger which was limiting her progress.
- The council’s vulnerable adults policy provided clear guidance on how to approach the issue of financial abuse.
- Without being accusatory and guided by the strategy meeting, Sloman managed to gain Heather’s agreement to have the missing money investigated by police.
- Heather was making contacts in the home – which she knew before from respite stays – and was thus less reliant on the Bevans who had reduced their contact anyway.
- There was also a strong possibility that with pressure being applied to Brian, who was very controlling, he would in return apply pressure on Heather to change her mind.
Arguments against risk
- Although the Bevans were in control of Heather’s money this did not mean that they were exploiting her. She gave all her money to them while she was temporarily staying at their house, partly because she wanted to compensate them for taking her in.
- The Bevans were the only members of the family who would have anything to do with Heather. Heather was very clear that she viewed them as a positive part of her life.
- Although having learning difficulties Heather is still an adult with capacity to consent. She was happy for her brother-in-law to become her financial appointee. She was very loyal to them – and loyalty is not easily won. They must have been good for her.
- By prosecuting the Bevans there is a risk that her only family contact – and indeed any contact outside the enclosed walls of the home – would be lost to her detriment, leaving her isolated.
Mark Sloman had the courage to act on his intuition that something was amiss in the relationship between Heather and her brother-in-law, writes Alan Corbett.
In such complex cases gut feelings about a situation should be evaluated alongside more concrete evidence. The relationship between Mark and Heather has clearly been absolutely central to its resolution. Taking time to engage with Heather, paying attention to the signals she was giving and feeling confident in making sense of the mixed messages were clearly important.
The central dilemma – Heather’s “fierce loyalty” towards her brother-in law – is a common issue in working with victims of abuse, be it financial, emotional or sexual. Heather has had a history of traumatic loss – of home, services and mental health. It is small wonder that her attachments take on such an adhesive quality.
I am concerned about the absence of learning difficulties services. There is a danger of her history of psychosis overshadowing her other needs. The strategic work lacks a learning difficulties perspective that may have much to offer in terms of assessing and working with her vulnerability.
I would now wish to explore psychotherapeutic support for Heather to enable her to sustain the excellent progress she has made. It is to be hoped that her multi-agency support does not end at this crucial point.
Alan Corbett is director of Respond, and member of the Adult Protection Alliance. More on Respond at www.respond.org.uk