Risk Factor: Helping a carer with more home support

The importance of safeguarding vulnerable service users has, quite rightly, been highlighted in recent years. But sometimes it is carers who find themselves being manipulated by others. Richard Pearl, a social worker with older people, describes a complex case involving a mother and daughter.

“The initial referral was for the mother concerning carer support and possible housing issues,” he explains. “I went there to assess the mother’s needs, but also with a view to looking at the carer support too.

“What struck me was that the relationship was under duress,” he says. “The only time Daphne got out of the house was when she did the shopping. It was obvious that the daughter was under incredible stress. She was shaking during the assessment.”

Pearl felt that respite was “the natural thing to suggest”. Muriel, on the other hand, had little desire for anything to change.

After weeks of encouragement from Pearl, Muriel relented and agreed to spend some time in a respite home. Pearl gave Daphne a lift to pick Muriel up from her respite stay and it was on this short journey that Daphne’s concerns came tumbling out

 “She said that her father had left the household when she was in her teens and she had been taken out of school permanently to care for her mother,” Pearl says. “Her mother was possessive and controlling, restricting whatever she did, not letting her have a job or a social life. She was also abusive, both verbally and psychologically.”

Additional home care support

Pearl put in place some additional home care support. He also tried to persuade Muriel that her daughter was stressed. She refused to accept this. “As a result, things got slightly worse,” he says. “I later found out that she would throw things in a rage when I had raised concerns about her daughter.”

Muriel went into respite several more times. This gave Daphne a chance to contact refuge staff on the phone. She contemplated leaving home, but was afraid of the consequences. “I helped her contact a local women’s refuge,” says Pearl.

“Initially she was concerned that her mother would carry out a threat to kill herself. I never thought there was a real risk of this happening, but you can never be sure.”

During one of her mother’s respite stays, Daphne plucked up the courage and left for the refuge with help from Pearl. “She absolutely thrived there,” he says. “She did things she had never done before such as making friends and going on the bus alone. She saw the sea for the first time. She gained an awful lot more confidence.”

Return home

A year on, Daphne decided to return to her home town, where she found her own flat and attended an adult learning centre. Although she experienced some problems with independent living she managed to live alone for about six months, during which time she visited her mother.

In that period much had changed with her mother. “Muriel had also started going to a day centre and had become more independent. She made her own friends at the centre and enjoyed the activities, such as bingo,” says Pearl.

Eventually Daphne decided to move back in with her mother. Pearl saw how the power differential had changed: “It was a much more equal relationship. Her mother was now less dependent and they both had lives of their own. It was a much improved situation.”

Arguments for taking a risk

● The situation could not carry on as it was Daphne was being abused, both verbally and psychologically, by her mother. She was under tremendous stress and not intervening would have been damaging for her.

● Support for Muriel if Daphne leaves Pearl ensured that there was plenty of support in place for Muriel, should her daughter decide to leave. This included home carers.

● Space away from each other Pearl was able to negotiate changes that gave both of them space from each other and promoted their independence. He was confident that by implementing these changes cautiously, his actions were in the best interests of both mother and daughter.

Arguements against taking a risk

● Difficulty maintaining two-way trust It can be difficult working with two members of the same family, particularly if information is withheld from one of them. This could have damaged trust between family members.

● Intervention might not have worked out There was a possibility that the refuge might not have suited Daphne and could have made her situation worse, resulting in her being unhappy.

● Possibility of Muriel’s suicide Pearl could never be entirely sure that Muriel wouldn’t kill herself when Daphne left. If Muriel had taken her own life, this would have had a devastating impact on Daphne.

Independent comment

The one guaranteed thing in social work is that nothing is ever as simple as it first seems. What appeared to be a service user and carer relationship was in fact more a case of two individuals being mutually dependent as a result of the negative behaviour of one.

The social worker in this case has essentially approached this as two service users and assisted them to become less dependent and take control over their lives. This allowed each to go their own way. It is fortunate that the worker was able to separate the issues for them as this usually proves very difficult.

When service user consent keeps changing, working out what information to share and what not to can prove impossible.

It may have been helpful to assign separate workers for each so as to ensure they were both supported. However the two workers would need to work closely with each other and ensure that the risks are fully assessed.

The case highlights a number of risks, in particular Muriel’s potential suicide. A formal risk assessment can be helpful in a case where somebody is using it to control others. Usually such people score as a low risk unless they are particularly adept at manipulation.

Lance Carver,: service manager, Herefordshire Council

This article is published in the 6 August issue of Community Care magazine under the heading Caught in a parent trap