By Elaine Cass
When people choose, or at least appear to be choosing, to cause harm to themselves or put themselves at risk, for example, through self-neglect or remaining in an abusive relationship, it presents a dilemma to social work practitioners. There are aspects of this area of work that lie at the heart of social work, such as relationship-based working, but these type of situations continue to challenge even the most experienced workers.
The Care Act 2014 requires us to take a personalised approach to adult safeguarding, ensuring that wherever possible the individual at risk of harm remains in control, making their own decisions and judging what is best for them.
To hear more from Elaine Cass on this subject, sign up to Community Care Live where she is running an adult safeguarding dilemmas workshop. Case study material will be used to help participants expand the range of responses available to them when working with complex and challenging situations.
Nevertheless, practitioners continue to have safeguarding responsibilities. They need to work in partnership with other organisations, such as domestic abuse services, and connect with safeguarding forums. On self-neglect, key partners may be housing and environmental health.
Social workers need to know when and how to share information, when to intervene against the will of the individual, and how best to do that. Practitioners must have a good understanding of the Mental Capacity Act 2005 and strong risk management skills. They should be supported by good systems and management in a multi-agency environment; referral routes should be clear; and systems should be in place to enable appropriate information sharing and resolve disputes over responsibilities.
Good social work practice can empower people to consider different options and think about how their life could be better, especially if care is taken not to damage valuable relationships or remove control. Understanding all the options and the relevant law can help practitioners be creative in their responses to very difficult circumstances. Risk enablement is a process and a skill that will support maximum independence of decision making for those at risk, but this must be facilitated through shared responsibility and a multi-disciplinary approach.
Social work practitioners need to have an excellent understanding of all the options to be explored in complex safeguarding cases. They will need to understand the ways in which coercion and duress can influence capacitated decision making and what the legal options are for intervention. Social workers also need to know how independent interventions, such as family group conferences or mediation, can empower people to make their own decisions and use their own resources.
Elaine Cass is practice development manager at the Social Care Institute for Excellence