Woman with multiple sclerosis harbours drug-using daughter

Mum with MS harbours drug-using daughter

published in the 26 March issue of Community Care

CASE STUDY

Situation

Sarah*, 42, has multiple sclerosis, an unstable form of diabetes and lives in a housing association warden-aided bungalow. She is a wheelchair user and needs help with all her personal care. She has a violent partner who has just come out of prison but she has capacity and is a strong character. Sarah’s daughter, who is 20 and a heroin and crack user, lives with her on an intermittent basis. This is despite the housing association putting a clause in the tenancy saying she must not reside at the bungalow. The daughter visits on the day Sarah receives her benefits and her mother gives her money which she spends on drugs.

Problem

When the daughter stays at the house her friends, drug users and dealers, often come round. Home helps, social workers and district nurses, who help Sarah with her insulin daily, often don’t feel safe entering the house. Drug users sometimes come to the door and there have been syringes on the floor in the past. Risk assessments have been carried out and staff don’t enter the house if the daughter or Sarah’s partner are there. Social care staff visit in pairs. Sarah is being treated as a vulnerable adult, safeguarding procedures have been invoked and there is very close multi-agency working between social care, health, the police and housing staff. Sarah sometimes goes out to have a drink, misses her appointment with the nurses at the house and has to go into hospital due to not receiving her insulin.

* Name has been changed

THE SOCIAL WORKERS’ VIEWS

Craig Nolan, a care manager of a physical and sensory disability team at St Helen’s Council

The key to tackling the present situation would be to establish a service user perspective, which would inform and determine the approach to be adopted.

If Sarah wants to maintain contact with her daughter then a “supportive approach” would be adopted (see Gill Craig’s advice). If, on the other hand she feels threatened by her daughter then a “protective approach” is needed.

For example, financial abuse may be occurring, which would need to be explored using adult safeguarding procedures. If an investigation confirms this then – with Sarah’s consent – a plan must be implemented to manage this.

If Sarah does not wish to make an official complaint to the police but wants her daughter to stop visiting her then she could apply for an occupation order under Part IV of the Family Law Act 1996. This regulates who can live in the family home and could restrict her daughter from entering. If Sarah’s daughter breaches the order then the police could arrest her. Home care staff will monitor the situation and report back any concerns to the social worker.

The issue of Sarah missing occasional appointments with the district nurses can be tackled through the two co-ordinating their diaries and Sarah letting the nurses know by mobile phone when she wants to go out for a drink so they can visit accordingly.

Gill Craig, a senior practitioner in a physical and sensory disability team at St Helen’s Council

A “supportive approach” enables Sarah to maintain her independence and contact with her daughter if she wishes. Interventions would be determined by safeguarding recommendations and involve a multi-disciplinary agreement.

A clear plan of support would need to be produced containing targets and boundaries. This would be monitored each month by the multi-disciplinary team and evaluated after three months.

Sarah is the main person affected by her daughter’s actions and is the only one who can affect change. Sarah presumably has the capacity to decide who can enter her home and our role would involve helping her to have the confidence to solve the problems herself. We have a duty to protect staff within Sarah’s home and the provision of a “sharps box” for used syringes could further minimise risk. Additionally an agreement should be sought with Sarah’s daughter that drugs will not be used or visible during the times that support staff are present.

Sarah’s daughter residing with her can be interpreted as a breach of her tenancy agreement and so every effort must be made to make her aware that this may lead to her being evicted.

Finally, Sarah’s lifestyle is a choice. If she did not have MS or diabetes, it would be unlikely that support services would be involved.

THE SERVICE USER’S VIEW by Simon Heng, a wheelchair user (right)

Like Sarah, I am a wheelchair user who needs help with all of my personal care. I also have Type 2 diabetes. Without any other complications, dealing with these disabilities takes some consideration and organisation, without having to deal with Sarah’s risky and chaotic relationships.

But Sarah has chosen to, and has a right to, maintain these relationships and to expect non-judgmental care and treatment, as long as the risks are minimised to an acceptable level for the people helping her.

The problem boils down to Sarah missing her insulin appointments with the nurses, which damages her health – although the drinking itself might also be risky due to her diabetes. Although I believe she has a right to lead her life the way she wants, I also believe she needs to take responsibility for looking after her health and that includes keeping appointments with health workers.

Is it possible that she might be using her hospital admissions as a way of taking a break from the rest of her life – even though her way of getting there is so risky? Does “going for a drink” always involve getting drunk? Or does she forget the appointments because her memory has been affected by the MS? She may just need a simple behavioural contract or to have a few appointment reminders pre-set onto her mobile phone.

Do you have a view on this case or another case that would be of interest to readers? Let us know at comcare.features@rbi.co.uk