Thinking outside the triangle

CASE NOTES
(The names of the tenants have been
changed)

PRACTITIONERS: Debbie Owen, social worker,
learning difficulties, and Glyn Rocke, approved social worker, 
older people.
FIELD: Adult protection.
LOCATION: Telford, Shropshire.
CLIENT: Albert Green, 88, lives in a ground floor
maisonette with his younger wife Lesley, 57, who has learning
difficulties. Another man, Bryan Gibbons, 63, believed to be
Lesley’s cousin, also lives with them. 
CASE HISTORY: Following concern about the
condition of the property and the noise, including shouting by the
tenants, the social landlord threatened eviction. A senior social
worker from older people’s services visited the home to find it
crammed with possessions and rubbish. There were also about 15 cats
living in the property and their urine and faeces were everywhere –
including kitchen worktops. The smell was described as
“intolerable”. Environmental health officers were also concerned. A
vulnerable adults meeting was called because of the threatened
eviction but also because the unclear relationship between the
three people was ringing alarm bells. 
DILEMMA: Given past bad experiences with social
services, workers knew that if they put too much pressure on Bryan
and Lesley, they would run away.
RISK FACTOR: Working to keep them from being
evicted meant the three would remain together even though their 
relationship hinted strongly at abuse. 
OUTCOME: All three remain together but the
situation is being monitored and there are options and support for
Lesley and Albert should either decide to leave.  

When social services staff became involved with a referral from
a social landlord, they thought they were dealing with a potential
eviction. The tenant Albert Green, 88, his much younger wife,
Lesley, and another man, Bryan Gibbons, 63, were living together by
choice in unhygienic conditions. There were also complaints about
the noise.

Although the threat of eviction was real and with good cause, it
was the unclear nature of the triangular relationship between the
occupants, especially as Lesley appeared to have learning
difficulties, that proved equally unsettling as the odour and their
living conditions.

Glyn Rocke, approved social worker for older people, says: “We had
reports that, on visits to the home by the Supporting People
worker, Bryan was always present in the background and had an
aggressive and intimidating demeanour. Although unable to pinpoint
it, the worker felt there was some underlying abuse going
on.”

A vulnerable adults meeting, involving police and environmental
health agreed that Albert and Lesley should be interviewed, but not
Bryan, at the offices of the social landlord so as to not raise any
suspicion or fears. Service manager Amanda Wollam says: “At that
meeting we involved a worker with the learning difficulties
service. We also included a member of the community mental health
team to make a judgement on Albert’s capacity to consent.”

The couple were interviewed separately. Learning difficulties
social worker Debbie Owen says: “Lesley said she would like to live
on her own but was worried about Albert if she left. Later we found
out that, many years earlier, Lesley had her child taken off her by
another local authority, which accounted for her mistrust and fear
of social services. This also sometimes influenced her to say what
she believed we wanted to hear rather than what she wanted to
say.”

However, there was another potential problem that had to be
managed, as Wollam explains: “We discovered they owned a caravan a
few miles away, and Bryan was, we think, making Lesley walk to this
caravan with him every weekend. We didn’t know where it was but we
realised that it was a place that they retreated to when the going
got tough. So it was important that we worked with them in a way
that wouldn’t create fear or alarm.”

The condition of the property, however, proved a shock for those
involved, recalls Owen. “It was the smell that hit everyone. Cat
urine and faeces was on all work surfaces. A pet dog that had been
missing for about six weeks was found dead under the bed.”

The threat of eviction needed to be tackled immediately. Owen says:
“We’d go in one week and give them a set cleaning task, which by
the following week would be done. This reduced the risk of the
property being declared filthy and full of vermin. Also, Lesley’s
cats were removed with her permission. With these improvements a
support worker was allocated to work with them.”

Indeed, the role of the support worker – a male, as Bryan had been
intimidating to female workers – was pivotal. “He’s been
excellent,” says Rocke. “He’s built up a terrific relationship with
all three of them.” Owen agrees: “Bryan lets Lesley go alone with
the worker in the car to the garage, which is a big step because
Bryan would rarely let Lesley go anywhere without him, apart from
collecting her money. Indeed, financial abuse is another of our
concerns.”

Indeed, Owen now meets Lesley covertly because her client is unable
to speak freely while Bryan is around. “She said she’s happy for
most of the time at the flat, but didn’t always get on with Bryan,”
she says.

But concerns about the relationship continue, not least with Bryan
apparently sleeping in a single bed in the same room as Albert and
Lesley. “I was concerned about the relationship between Lesley and
Bryan. There are several issues of possible abuse, but Lesley has a
network of support that can offer her choices to leave,” says
Owen.

The situation continues to be monitored, but all three seem linked
into a triangular relationship that no one wants to break –
yet.

“There were two key risks,” says Wollam. “First, that they would
become homeless; our intervention and negotiation with the social
landlord and environmental health has reduced that risk. Second,
there is risk of abuse. Our work, while perhaps not greatly
reducing the risk, has certainly provided them, particularly
Lesley, with choices that, if they wanted to leave the situation,
they could.”

Arguments for risk

• Having been able to build up a relationship with Lesley the
  workers can offer her alternatives should she wish to move out.
  Owen says: “It is about giving her the opportunity to say ‘I want
  to get out of here’. At the moment she is not saying  that. We
  still don’t know the full extent of what is happening: none of them
  are saying. But they all have capacity to consent and it seems that
  they don’t want this triangle to break.”
• With the help of the Supporting People workers the flat has
  been cleaned and the possibility of eviction on health grounds has
  been minimised.
• Regular meetings are held to monitor the situation.
• Progress is definitely, if slowly, being made. Owen says:
  “We’re achieving something by just getting into the house because,
  previously, in another local authority they simply refused any
  support from social services or other departments. In the past they
  have just left.”  

Arguments against risk

• The sub-text is strong. Bryan is the root of the unease and
  uncertainty. It does seem to suggest that he is financially,
  psychologically and sexually abusing Lesley. Albert may well be
  psychologically and financially abused by both Lesley and Bryan.
  Leaving them at the apparent mercy of Bryan is a troubling
  thought.
• However, Lesley’s experiences with social services and the pain
  of change may well be too strong for her to act voluntarily on the
  offer of support should she move out. Sometimes it is just what you
  know that makes you feel safe – even though it patently is
  not.
• It is worrying that the three of them could allow the place to
  get into such a state  that the environmental health department was
  considering eviction on the grounds of “filthy and/or verminous
  premises” under section 79 of the Environmental Protection  Act
  1990 and section 83 of the Public Health Act 1936. This affects
  more than just the three of them.

Independent Comment 

I read this case study many times to try to understand the
inter-linked relationships, the dynamics and the emotional
attachments. It took a long time and I do not envy Debbie Owen and
Glyn Rocke’s task working with these three people, writes Kathryn
Stone.

The workers rightly sought to first tackle the cause of the
threatened eviction – the state of the property. And this meant
cleaning the place up and supporting Lesley, Albert and Bryan to
take responsibility for this. But I wondered what steps the social
landlord had taken to support them or what other supports could
have been available to prevent their environment becoming so
hazardous in the first place.

I also wondered about the workers’ acceptance of Lesley’s position.
Is Lesley saying “I want to get out of here”, given that she has
said she’d like to live on her own but is worried about Albert. Why
not pursue this avenue more keenly?

Rocke and Owen have made progress by getting into the house and
then cleaning and organising things. The confusion for me seems to
be the lack of intervention on an emotional level. Lesley, Albert
and Bryan may well all be depressed. A lack of self-esteem, not
caring for yourself or your environment could be viewed as
indicators of depression. Lesley has also lost a child.

Owen could take advice from Respond (www.respond.org.uk), an
organisation that provides therapeutic support for people with
learning difficulties.

Lesley, Albert and Bryan need support on several levels. Owen and
Rocke have established a level of trust with them and it is to be
hoped this will continue. 

Kathryn Stone is director of Voice UK, a national learning
difficulties charity