Get me out of this house

A man with Asperger’s syndrome reports theft and abuse in the house he shares but services have failed to respond

Practice panel – Learning Disabilities Team – Bath and North East Somerset (BANES)

Case study
The names of the service user and his brother have been changed
SITUATION: Adam Silver is 27 years old and has Asperger’s syndrome. He has been placed by social services into a shared house with two women. The house is staffed by workers from a voluntary organisation for two hours in the morning and two hours in the evening. The two women are recovering drug addicts, receiving additional support from the hospital outreach team.

PROBLEM: Adam has told his brother, Joe, that the women have lots of male visitors who pay them for sex and they use the money to buy drugs. They have told Adam not to tell anyone about this. Last month Adam went to see his brother and was very upset. He said that one of the men had said that Adam had to “do sex” with him. Adam said that the man was very nasty and started to hit one of the women. Joe has been to the house and was concerned to find that most of Adam’s clothes had disappeared as has the TV/DVD player Joe and his wife gave him for Christmas. Adam has no idea where these items are. Joe has been in touch with social services who pay for the placement. A worker there told Joe that Adam was an adult and could have sex with who he liked and that it was likely that Adam had disposed of the TV and clothes. Adam is very unhappy and says that he wants to run away.

Panel responses
Helen Thompson
Adam must be distressed and frightened in this environment. Social services’  response to Joe has been disappointing and I get the impression that Adam does not have an allocated social worker.

Within Bath & North East Somerset, people with Asperger’s do not necessarily receive support from the community learning difficulties team. Instead this is usually provided through the adult mental health services. Adam would only be entitled to input from the community learning difficulties team if clear evidence existed that a learning difficulty was his predominant need. Through an integrated health and social services referral meeting we would find the best professional to respond. The immediate action would be to safeguard Adam’s welfare and in view of the evidence of physical abuse, sexual abuse, harassment and intimidation, the interagency vulnerable adult procedure would be launched. It appears that several crimes have been committed and so the police would need to be involved. Adam would be central to all investigations and an adult protection plan needs to be agreed upon. The professional obligation to share concerns with the hospital outreach team about the women
in this household also needs discussing.

The environment in which Adam is living is clearly unsatisfactory. It appears that this is a supported living house in which Adam is a tenant. If he intends to stay in this accommodation we would be looking at ways to increase his safety by interlinking with appropriate agencies. If Adam prefers to leave and is unable to move to friends or family, social services would support him to find new accommodation. Adam has had an awful experience and an inadequate and untimely response from social services. He should be encouraged to voice his experiences.

Advocacy can be arranged to support him with this and official complaints procedures should be used. In the long term, Adam and his circle of support may have more confidence in self-directed support through an individualised budget. Regular reviews would be built into this process to ensure that Adam’s support was more person-centred and tailored to his needs.

Linda Walz
As a man with Asperger’s syndrome, Adam is likely to need specialised support from staff who understand his needs: for example, a structured day with routines and his likely difficulties with managing social situations. The support staff may not have the correct training given the mixed nature of the client group living in the house. Training could possibly be accessed through the local mental health or learning difficulties teams or via an organisation such as the National Autistic Society. Adam may or may not have a learning difficulty alongside the Asperger’s syndrome and it might be useful to carry out a cognitive assessment. This would help staff understand his needs in terms of understanding and processing information given to him, his memory and his understanding of social situations. It would also provide information about his capacity
to consent to sexual relationships and to dispose of his goods. The assessment of capacity should include exploring his confidence in asserting himself in the situations under consideration. This information should inform the vulnerable adults process that should be started.

Therapeutically, Adam may want some support (for example, from a clinical psychologist who understands the implications of Asperger’s syndrome) to deal with the emotional aspects of his recent experiences. We do not know how long he has been in the house and it may be that Adam has been “suffering in silence” for some time .
People with a learning difficulty are particularly vulnerable to abuse because of issues of power and communication. Adam’s understanding of sexuality should be explored and he should be offered support to develop his assertiveness skills. A community nurse could help him understand the potential health risks of sexual activity and support him through the screening process for hepatitis and HIV. If Adam does stay at the house, safeguards will need to be put in as he may have put himself at risk by
complaining.

Joe is clearly closely involved in Adam’s life and should be supported in his role as Adam’s advocate. The response he received from social services was inadequate and demonstrates a lack of understanding of the implications of Asperger’s syndrome.

User view
What on earth is going on here? Adam clearly needs a different type of support from that of the women he’s sharing a house with, writes Adele Medhurst.

The placement should be reviewed and more suitable accommodation and support should be found for him. What is the charity providing support doing? Has its workers not spotted difficulties in the placement arrangements?

Adam has made a very serious allegation. This  allegation needs to be investigated by the police as does the disappearance of his belongings. At Voice UK we often hear of similar allegations being dealt with either by “in-house procedures” or being dismissed all together. Adam is telling us about alleged crimes that have been committed against him so the police need to be involved.

The police should interview Adam as a vulnerable witness and make sure he understands his rights to apply for special measures. These measures mean he can be supported to give his best evidence. An intermediary, a specialist supporter with skills in facilitating communication and who has additional training in legal proceedings will be able to help with making a statement and, if necessary, in court. The police need to be linked closely in to the multi–agency adult protection panel. There needs to be a
strategy meeting at the very least to ensure that all concerned are aware of the difficulties and can come to some agreement about the next steps.

It is simply not good enough to say that Adam can have sex with who he likes. Of course he can, we know that. Adam is saying he doesn’t like it and it makes him frightened. No wonder Joe feels like he is going around in circles. Our experience is that family members are often treated as a nuisance. They are people who just ask difficult questions and get in the way of the professionals who clearly know best. What happened to working in partnership with families to achieve the best outcomes for vulnerable people?

Joe needs to start complaining. There are organisations that will be able to support him. The National Autistic Society will be able to offer support about Adam’s needs in relation to his autism. Voice UK can offer support about what the police should be doing and how to use the complaints procedures.

Vulnerable people who make allegations of abuse need to be listened to more carefully and supported far more sensitively than in this case.

Adele Medhurst has learning difficulties and works as a volunteer at Voice UK