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A man with learning difficulties says his carers - relatives of his    mother's boyfriend - have assaulted him. Our panel advises

Case study

The names of the service user, his family, friends and carers have been changed

SITUATION: Alex Hutchison, 27, is a man with learning difficulties who uses a wheelchair and has little verbal expression. He had lived all his life with his mother, Sarah. His father died nearly 20 years ago. For the past year Sarah has been in a relationship with Don Heath - her first long-term relationship since her husband's death - and they plan to marry. However, there is friction between Alex and Heath. Heath had been pushing for Alex to go into residential care. Finally, Sarah agreed.

PROBLEM: Alex's social worker felt that supported living would give Alex more independence. Sarah and Heath disagreed - saying Alex would not cope on his own. However, they agreed to help appoint Alex's carers. It emerges that two appointments - Alison Moran and Micky Doyle - are Heath's relatives. Within a month of moving into his own flat, Alex told his social worker that he is often shouted at, bullied and punched by Doyle. Possessions have also been stolen - Alex says - by Doyle. A police officer decided that, because Alex has problems making himself understood, he could not be a witness. The social worker thought some questions were too complicated for Alex (for example, "If I said my jacket was crimson - would that be the truth or a lie?"). Heath says that Alex is making it up to gain revenge because he (Heath) is now with Sarah. The social worker wants to take things further but isn't sure how.

Practice Panel - Learning difficulties service, Bath and North East Somerset (BANES)

Panel responses
Andrew Luff
This is a contentious situation that needs sensitive handling. There appear to be two main issues. First, the need to ensure that Alex is enabled to determine his own life choices and be empowered to make decisions for himself. For this the social worker needs to obtain an advocate to help Alex negotiate and assert his wishes with his family.

Second, there is strong prima facie evidence that Alex is or has been abused by his carers and that he may be the victim of a crime. Under the Department of Health guidance No Secrets, the local authority should have an interagency procedure for the protection of vulnerable adults. I would recommend it convenes an initial strategy meeting to include the police as co-signatories to the policy.

The purpose of the meeting would be to evaluate the evidence, agree on any immediate action, such as the need for further investigation, and determine a risk protection plan. I do not think it is acceptable for the police to pre-determine Alex's ability to be a credible witness. A core purpose of the strategy meeting will be to determine how best to interview Alex and what assistance he may need.

The social worker may find it useful to advise the police of the guidance in Vulnerable Witnesses: A Police Service Guide. This document emphasises an individual's right to receive equal treatment in the criminal justice system. The guidance provides useful prompts and suggestions on how to assist vulnerable witnesses when being interviewed. One way to ensure that Alex is adequately supported in this process is through the support of an "appropriate adult". This could be a role for the social worker to undertake.

If there is clear evidence of a crime against Alex, and the Crown Prosecution Service decides to proceed to prosecution, he would be eligible under section 21 of the Youth Justice and Criminal Evidence Act 1999 to have an "intermediary" appointed by the court. The principle function of an intermediary will be to address the complexities of finding an effective communication process between Alex and all members of the court and criminal justice system.

Linda Walz
Leaving home and adjusting to adulthood can be a stressful experience for anybody. Alex could benefit from individual sessions with a psychologist to explore his feelings about the move and his mother's relationship with Heath. Alex may be experiencing the move as a rejection by his mother rather than the opportunity for independence that his social worker sees. He may be frightened by the change and be feeling insecure; he may simply be missing his mother's company and feel lonely. This "loss" of his mother may be reawakening feelings about the loss of his father.

People with learning difficulties have often been excluded from discussions on bereavement as people think they would not understand. As a result, they can be left with confused ideas about what has happened and little opportunity to understand and express their emotions. Alex may also be concerned for his mother's welfare: he may have witnessed discussions between her and Heath where he was putting pressure on her to place Alex in residential care and be worried about his mother's vulnerability.

It would be important to untangle whether Alex's allegations against Doyle are a reflection of his emotional state surrounding the move or based in fact. A comprehensive speech and language therapy assessment would help clarify the best ways to communicate with Alex. This would help the psychologist within her sessions as well as the social worker and police in their questioning.

Alex is described as a man with little verbal expression; it would be useful to know how he has expressed distress in the past. Does he feel he has to make extreme statements to be listened to? A skilled family therapist might be able to help this family in understanding what is going on for all of them, or at least facilitate discussion between them.

Alex needs to feel in control of his life. It would have been better if the decision to consider supported living had arisen from a person-centred plan placing Alex at the heart of decision-making. The social worker should have ensured that Alex was trained in recruiting support staff and involved in their selection. He or she should have considered the use of direct payments to give Alex a greater sense of control.

User view
This isn't right, writes Daniel Hardy. What is happening to Alex is wrong and someone needs to do something about it. I don't see why his mother would go along with something that was hurting Alex. I don't understand it.

Perhaps she is too scared to say anything to Heath in case he refuses to marry her. But Alex is 27 and can make up his own mind about what he wants. He doesn't want to be bullied or have his stuff nicked.

The social worker and the police need to sort this out more quickly than they appear to be doing. Alex is being hurt and is scared. This is unacceptable, as everybody has the right to justice for the crimes that are committed against them.

Alex has made serious allegations of mental and physical abuse by Doyle, his care worker. Even though Alex told his social worker what was happening, the police say Alex is unreliable and will not be a good witness. They say this because they believe that Alex has problems making himself understood.

The Youth Justice and Criminal Evidence Act 1999 ensures that witnesses younger than 17 and other vulnerable people too, including those like me with learning difficulties, are given the right type of support in order for them to communicate with police and lawyers and then be able to go on and do their best in giving evidence in court.

If Alex uses a communication board in his daily life, he is surely able to use it in court. In order for the courts to understand what Alex is saying and for Alex to understand any difficult questions put to him by the prosecution or defence, he could use an intermediary.

An intermediary is a trained person who helps a witness who has problems in understanding questions or who the court might find it difficult to understand. An intermediary is a "go-between" for the court officials and the witness. This means that questions that may be too complicated for Alex can be explained in a way so that he will be able to understand. Alex will then be able to contribute to a fair trial where the courts will decide whether the accusations made by Alex are true.

As well as sorting out all the criminal stuff, Alex needs to sort out how he feels about all this. I think it would be sad for his mother to be like that: perhaps she doesn't really want to be but just has to go along with stuff.

Daniel Hardy is equal access to justice project worker at Voice UK, a learning difficulties charity