Practice panel: Is this client culpable or vulnerable?

Social workers and a service user offer advice on a case that hinges on assessing a person's mental capacity

Social workers and a service user offer advice on a case that hinges on assessing a person’s mental capacity

The Situation

Geoffrey* is a vulnerable 38-year-old with mild learning disabilities and alcohol dependency. He had a chaotic upbringing and now has little contact with his family, all of whom have a history of alcohol abuse.

Having recently moved into his own flat, he is now exploited by drinkers who are targeting him because of his vulnerability. Geoffrey receives substantial welfare benefits and there are concerns his associates are financially exploiting him. At his flat, his friends use drink and drugs. Sometimes Geoffrey seeks their company; at others they stay at his flat against his wishes.

The police have been involved but are reluctant to intervene as Geoffrey is seen to have mental capacity and is able to decide on the company he keeps. They feel he is complicit in his associates’ behaviour. He has been known to the local learning disabilities team for some time and his social worker is now visiting him several times a week to deal with anti-social incidents and neighbours’ complaints.

The Problem

Geoffrey would like to move. However, the local housing services are unsympathetic and unwilling to move him. Accessing private sector accommodation is difficult as Geoffrey has a conviction for arson (which may have to be disclosed) and is unlikely to be organised enough to save money for a bond and advance rent for a private flat.

Recently there has been an escalation in violence at the property, raising concerns about Geoffrey’s physical safety.

* Name has been changed


The social worker view

Deborah Wales and Cara Hawtrey, assistant manager and social worker, community learning difficulty service, Bath and North East Somerset

An informal one-to-one meeting should be arranged between Geoffrey and his social worker at a mutually agreed place, away from his flat. There it could be established whether or not he actually wants these people visiting his flat, and strategies on how he could be supported to deal with these issues and improve his living situation could be discussed.

He has already identified a wish to move, so he is obviously unhappy with something. He could be asked if he would like a referral to be made to an independent advocate who would assist in advising him of his rights.

The social worker could also support him to become aware of the impact of his behaviour on his neighbours and to gain an understanding that he is responsible for some of what is happening, which could ultimately lead to his eviction.

The social worker should ensure legal advice on housing is obtained from their department’s solicitor. A multidisciplinary meeting should be held, including representatives from housing and the police.

Assuming Geoffrey has already been assessed as eligible for social services, he could be offered a personal budget, though this would need to be a managed account to avoid further risk of financial exploitation. This would enable him to have a support worker who could help support Geoffrey to move and to become involved in meaningful activities.


The nurse’s view

Steve Knight, behavioural nurse specialist, community learning difficulty service, Bath and North East Somerset

A key issue is around Geoffrey’s capacity because the assumption is that he has capacity and is choosing the company he keeps. A mental capacity assessment would need to be carried out if this hasn’t already been done, as his association with the other drinkers is putting his tenancy at risk and making it likely that he will come into contact with the criminal justice system.

Placing this case under local safeguarding procedures would ensure that the relevant agencies meet to review his safety and develop an action plan. This would need to include an agreed response by the police to incidents of anti-social behaviour and drug taking that was sensitive to the fact that Geoffrey is being exploited.

Housing services are an integral part of the discussions because of the complaints from neighbours but can also be supportive in looking at suitable alternative accommodation. Clarification of the arson conviction is important because this could limit future housing options.

Ongoing support should be given by the community learning disability team through the care programme approach process, ensuring ongoing risk assessments and a crisis plan is in place. The team also has a role in supporting him to access alcohol advisory services and helping him with appropriate coping strategies.

It may well be though that if Geoffrey is assessed as having capacity and he chooses to continue to make unwise decisions and ignore professional advice then this will progress through the criminal justice system.


Service user response

Richard West, director, Inspired Services

The social worker needs to help him keep his benefits safe so his rent and other bills are paid and he doesn’t end up homeless as well.

Lots of people with learning disabilities are lonely and if they do get out they can be targeted by others. This can easily happen when people are housed in rundown areas. It doesn’t give vulnerable people much of a chance and why housing departments do this is beyond me. We then see people with learning disabilities getting into trouble and ending up in a prison system that doesn’t meet their needs either. Housing must move him.

Unfortunately, the decision for Geoffrey to move into his own flat doesn’t seem to have been done with a good person-centred plan to support him towards a different lifestyle. If there was a plan we need to look at what went wrong and try to help him break the cycle of what is happening here.

We do need to make sure that this is what he prefers to do. There are many people with learning disabilities who are now saying they want to do things with other people with learning disabilities. Perhaps he could become part of a self-advocacy group?

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This article is published in the 10 June 2010 edition of Community Care magazine under the headline Is This Client Culpable or Vulnerable?

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