My practice

Despite the many inter-agency procedures that provide partnership
and co-operation for everyone involved in the care of vulnerable
adults, it can still prove hard to define issues around capacity to
consent.

Julie-Ann Jones* is a 21-year-old young woman with
a mild learning difficulty. She lives at home with her mother,
Sarah,* and mother’s partner,
George.* Her mother has mental health
difficulties.

Like anyone of her age, Julie-Ann enjoys going out. She attended
our day service to engage in more meaningful activities than
spending most of her time in local pubs. But her attendance became
erratic, and her mood, appearance and anxiety levels all
deteriorated. She often said her mother and George were taking her
money. Her keyworker and the healthcare team kept a close eye on
the situation, sensing something was not quite right.

Then Julie-Ann called to say her mother had been admitted to
hospital following an overdose, and that it was all her fault.
During all the turmoil, Julie-Ann announced that her mother had
overdosed after finding out about Julie-Ann sleeping with George.

Julie-Ann was found an emergency respite bed, and the vulnerable
adult procedure evoked. A strategy meeting, which included police,
social services and health, discovered that Julie-Ann received
“payment” for sleeping with George, albeit just a packet of
cigarettes or a meal out. Not once during her statement did she say
that George had forced her to do it – in other words, she had
consented to the act. The investigation went no further.

I managed to maintain her attendance at the day service to monitor
how she was. Deep down I knew the situation would re-occur and was
not sure that Julie-Ann understood what was happening to her.

Six months later, Julie-Ann disclosed that she was regularly
sleeping with George for payment. The vulnerable adult route was
taken again, and this time the police did a video interview to try
and gain more evidence. Julie-Ann graphically described the acts
that had taken place, but again did not say that she had said “No”
or that any force had been used; as a result, she was considered to
have consented and we sent her back home again.

It leaves me feeling helpless and frustrated that Julie-Ann is
being taken advantage of. Or is she? The family obviously think
that this is the norm. My only hope is that one day Julie-Ann will
realise she need not be in the situation she is and move on. In the
meantime I have no doubt that the vulnerable adult procedure will
be revisited for Julie-Ann.

* Names have been changed

Nichola Edge manages a day service in Staffordshire
for people with learning difficulties