‘…items and belongings…’ – a hoarding case at the Court of Protection

Stephen Martineau summarizes a recent case at the Court of Protection involving hoarding behaviour: AC and GC (Capacity: Hoarding: Best Interests) [2022] EWCOP 39. With thanks to Neil Allen for alerting us to the judgment via this Tweet.

The NIHR Policy Research Unit in Health and Social Care Workforce, where Stephen is Research Fellow, recently completed a study of self-neglect and hoarding behaviour among older people and it has just commenced another study on the commissioning of decluttering services by local authorities. Both projects are funded by the NIHR School for Social Care Research. (2,294 words)

Introduction

This case concerned AC, a 92-year-old woman. She had been sharing her home (which she owned) with her son, GC, since her husband’s death eleven years earlier. GC had given up his job and had become his mother’s main carer. In February 2022 she was taken to hospital by emergency services and in March was discharged from hospital to a care home as a result of a best interests decision. There had been concerns about the unsanitary conditions at her home and their potential impact on her health and welfare.

The question to be decided in summer 2022 was whether AC should now return home for a trial period, receiving a package of care there. It was her wish to return home, while the local authority thought she should remain at the care home. We learn from this judgment (August 2022) that both AC and her son were diagnosed by a clinical psychologist, Professor Salkovskis, as having a hoarding disorder (among other conditions), and also that both have their own social worker.

The judge, HHJ Clayton, had already been managing the case for two years: there had been earlier applications to the Court of Protection by the local authority (and the judgment alludes to yet earlier proceedings that had ended in 2018). In August 2020, the local authority had applied for AC to be moved to a respite placement while the poor conditions at her property were addressed. More recently, it had sought an order that her son leave the property for the same reason.

Much of the difficulty of the case arose because of concerns around GC’s mental health. If AC were to return home, it was proposed that he would be the ‘second carer’ (after the care agency). Continue reading

Liberty, social care detention and the law of institutions

Stephen Martineau, Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce at King’s College London, reviews Deprivation of Liberty in the Shadows of the Institution by Lucy Series (University of Bristol). Page numbers in brackets refer to the book, which was published in March 2022 (and is available for free). (2,642 words)

Introduction

One of the more familiar stories from recent UK history about the lives of people with longstanding serious mental illness or intellectual or cognitive disabilities is their move from large-scale institutional accommodation to living arrangements beyond the walls of such places. The extent of this ostensible deinstitutionalization is illustrated by the decline in hospital beds for ‘mental illness’, ‘geriatric’ patients and people with intellectual/learning disabilities—from over 200,000 in 1955 to under 20,000 in 2020 (Series, 2022: p.53). Much of this shift was to do with the closing of survivals of the Victorian era (which started out being called asylums, subsequently renamed mental hospitals) that took place through the second half of the twentieth century.

As Lucy Series describes in her book, Deprivation of Liberty in the Shadows of the Institution, these newer smaller-scale living arrangements may take the form of ‘quasi-institutions’ (residential care and nursing homes) or ‘quasi-domestic’ arrangements (‘supported living’, ‘independent living’, sheltered housing), or indeed ordinary homes.

Series describes this development as a passage from a ‘carceral’ to a ‘post-carceral’ era (after Unsworth, 1991). But in making the physical move away from institutions, to what degree have some less tangible aspects of the old institutional life been carried over to those new living arrangements, as far as these individuals are concerned? To what extent, Series asks, are they still living in ‘the shadows of the institution’?

This question was brought sharply into focus in the UK Supreme Court case of Cheshire West, the litigation that forms the dramatic fulcrum of this book. The court’s approach meant that its definition of deprivation of liberty applied to a much wider array of living arrangements than had hitherto been the case, extending to private homes, where family members were the carers (or custodians?) of the person concerned. It is the socio-legal ramifications of this move (which Series views as transgressive) that are the main concern of the book. To put it briefly and in human-rights terms, in its approach to concerns about liberty in the area of social care detention—under article 5 of the European Convention on Human Rights—the court seemed to set up a clash with a set of questions belonging more under article 8 (respect for private and family life), to do with the distinction between institutions and homes.

This review is split into five short sections: 1. Social care detention. 2. The acid test. 3. Liberty. 4. Home. 5. Out of the shadows? Continue reading

On best interests: values and participation in mental capacity law

Stephen Martineau is Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (1,115 words)

At the British Academy earlier this month, Dr Camillia Kong (Birkbeck College) and colleagues presented their end-of-project findings on the place of values and participation in mental capacity law. As well as contributions from the research team, the day featured a group of international experts, three Speak Out Leaders from VoiceAbility, and it culminated in a panel made up of four senior former judges: Baroness Hale of Richmond, Sir Mark Hedley, Senior Judge Denzil Lush, and District Judge Margaret Glentworth.

Participation and values

The event coincided with the launch of the second of two films produced by the project. The first, from 2021, had addressed the importance of good communication with the person at the centre of Court of Protection proceedings and discussed some of the ways of enabling their involvement (see particularly the ‘role-play’ at about 22 mins in). Three contributors in the film, Speak Out Leaders from VoiceAbility, took part in a panel at the event. The new film, Making Values Matter in the Court of Protection, includes a remarkable ‘demonstration’ of the exploration of a person’s values by a barrister engaging with the person and their father (from about 9 mins in). By modelling one way that requirements in the best interests checklist in s.4 Mental Capacity Act 2005 can be met, it provides a corrective to any notion that a finding of incapacity in respect of a decision amounts to an ‘off-switch’ for a person’s rights and freedoms.* Continue reading

A matter of life or death: A rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care

Caroline Emmer De Albuquerque Green, NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, introduces a new report on what Safeguarding Adults Reviews tell us about mental health social care services for adults in London. The report was co-authored with Unit Director Prof Jill Manthorpe and Research Fellow Stephen Martineau. (500 words)

Safeguarding Adult Reviews show that social care can be a matter of life or death when it comes to people experiencing mental health problems. In this new report we focus on a sample of Reviews that bear witness to the sad cases of people who may have been needing or using social care services to support them with mental health problems but who died or had been harmed and where multi-agency working was explored by the Review process. As with all such Reviews, they are designed to help learning and so improve individuals’ care and systems.

Our report ‘A matter of life or death: A rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care under a new Mental Health Act’ was commissioned by LondonADASS (Association of Directors of Adult Social Services). We amplified the learning from Safeguarding Adult Reviews published across all London Councils between 2017 and 2020 and also consulted Coroners’ Reports to Prevent Future Deaths. Our analysis is being used by LondonADASS to inform debates about the proposed new Mental Health Act, where, curiously safeguarding appears to be overlooked. Continue reading

At the Association for Professional Declutterers and Organisers annual conference

Jen OwenJen Owen is a Research Associate at the NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London. (482 words)

Unit researcher Jen Owen virtually attended the Association for Professional Declutterers and Organisers (APDO) annual conference on 20th May 2021. APDO represents the UK decluttering and organising industry. Founded in 2004, it now has a community of over 400 professionals across the UK.

Caroline Rogers started off the day with a presentation based on her recent paper ‘Home and the extended-self: Exploring associations between clutter and wellbeing’. As a Professional Organiser herself, Caroline was motivated to study for a MSc in Applied Positive Psychology and Coaching Psychology, to see if the positive wellbeing outcomes of being on top of clutter she noticed in her clients were universal. Her presentation outlined the current significant gap in literature on clutter, and how she went about exploring the associations between home self-extension variables (subjective clutter, objective clutter, home self-expression and declutter habit) and wellbeing (measured quantitively through the PERMA model). Her findings challenge existing theories of clutter as being maladaptive, instead drawing attention to its subjective nature, and offer a refined definition of clutter as “A subjective experience of possessions (material or other) that inhibits the curation of self-identity at home”. Continue reading

Three early papers on self-neglect

At the NIHR Policy Research Unit in Health and Social Care Workforce we are undertaking two studies examining self-neglect, both funded by the NIHR School for Social Care Research. In an article published in The Journal of Adult Protection, for the project examining Adult Safeguarding Responses to Homelessness and Self-neglect, Stephen Martineau goes back to three pioneering research papers on self-neglect to consider what, if anything, they can feed into current debates. (787 words)

Patricia Shaw's contribution in the 1957 paper on ‘social breakdown in the elderly’

Patricia Shaw’s contribution in the 1957 paper on ‘social breakdown in the elderly’

While conducting a review of the self-neglect literature during this year, references to two early papers on the topic have come up repeatedly. The first, published in the British Medical Journal in 1966, by Macmillan and Shaw, is often described as the seminal academic paper in this field and drew on cases in Nottingham. The other is the Diogenes Syndrome article, by Clark, Mankikar and Gray, published in The Lancet in 1975; it derived from a study conducted in a Brighton hospital. Our new Journal of Adult Protection article examines these two articles plus a third, again by Shaw and Macmillan. This one dates from 1957 and, though it did not use the term self-neglect (rather, social breakdown in the elderly), it is the most vivid and interesting of the three.

There is a good deal of research interest in self-neglect at present. Following consultation with, and a survey of, practitioners, carers and service users (suggested by our Unit), the James Lind Alliance (2018) Priority Setting Research Partnership on Adult Social Work recommended that the topic should be a research priority. As well as the Unit’s two studies (details below), the NIHR has a call out for a study of self-neglect in the community (closing 28 January 2021). The need for such research is reinforced by Michael Preston-Shoot and colleagues’ new national study of Safeguarding Adults Reviews that were conducted between April 2017 – March 2019. SARs are commissioned where questions are raised about the way agencies involved in safeguarding have worked together in individual cases: among the 231 reviews the authors analysed, self-neglect constituted the most common type of abuse/neglect (featuring in 45% of the reviews). Continue reading

Action on Elder Abuse is now Hourglass

Richard RobinsonAction on Elder Abuse recently relaunched as Hourglass. As a research team we at HSCWRU have long taken a strong interest in this area, so we are very pleased to post this piece by Richard Robinson, CEO of the charity, in its new guise, and as it nears its 30th birthday. (760 words)

On 24 March 2020, as a nationwide lockdown was announced in a bid to protect UK citizens from the coronavirus pandemic raging across the world, Action on Elder Abuse relaunched under the name Hourglass.

While the timing was extremely challenging, the rebrand was a necessary effort to mark the start of the charity’s new course as a modern, public-facing organisation building on our almost thirty years of experience. If we were to modernise and become sustainable as a charity, we had to redefine ourselves so that we could successfully champion safer ageing and break down the barriers that foster age-related vulnerability.

The Hourglass mission is simple: end the harm, abuse and exploitation of older people in the UK. Continue reading

“Not good enough, CQC”

John Burton, a social care consultant and writer, gives his personal response to the recent Safeguarding Adults Review on Mendip House. John is the author of Leading Good Care, JKP, 2015 and What’s wrong with CQC?, Centre for Welfare Reform, 2017. (973 words)

I’ve been reading the safeguarding review of Mendip House, a care home for adults with autism in Somerset. (Safeguarding Adults Review. Mendip House by Margaret Flynn, January 2018.) The home was owned and managed by The National Autistic Society (NAS), regulated by the Care Quality Commission (CQC), and the residents were placed there by local authority commissioners from all over the UK but none from Somerset itself.

Mendip House has been described as “Winterbourne View without the cameras”: a thuggish gang of staff assaulted, taunted, and stole from the residents; managers were weak and complicit. Whistleblowers told the CQC and the senior management of The NAS, but—as at Winterbourne View—they were repeatedly ignored or fobbed off. The NAS made ineffectual internal investigations but did not alert the CQC or the local safeguarding service as they should have done. The placing authorities failed to monitor the care, safety and welfare of their residents, or whether the high fees were value for money. Whistleblowers left while the perpetrators of the abuse were ticked off but remained in post. In other words, no one did their job properly or considered the residents who remained at the mercy of a horrible regime. Continue reading

Young people and gambling in changing times: implications, risks and harms?

Caroline NorrieStephanie BramleyResearchers Caroline Norrie (right) and Stephanie Bramley from the Social Care Workforce Research Unit at the Policy Institute at King’s College London attended the 5th annual Harm-Minimisation Conference on Wednesday 6 December and Thursday 7 December 2017. (1,233 words)

GambleAware, the charity funded by gambling operators to fund treatment services, education and research to help minimise gambling-related harm in Great Britain, held its annual conference at The King’s Fund, London in December. This was a jam-packed two days of speakers and this year the focus was on two issues: 1) gambling and the implications for young people, and 2) gambling and sport. In this blog post we focus on the first subject, but a summary of content relating to gambling and sport is in GambleAware’s own conference report. Continue reading

Wandsworth Adult Safeguarding Conference – Modern Slavery and Partnership Working

Caroline NorrieCaroline Norrie is Wandsworth Enter and View Representative and Researcher, Social Care Workforce Research Unit, KCL. (612 words)

Public sector practitioners from across the Borough came together on 27 November, 2017 at the annual Wandsworth Safeguarding Conference – Working in Partnership, which took place in Wandsworth Civic Centre Town Hall.

The morning was dedicated to raising awareness of Modern Slavery and Human Trafficking. Attendees were informed about the high prevalence of modern slavery—the recruitment, transportation, transfer, harbouring or receipt of persons. Trafficking was defined as: the movement of people by means such as force, fraud or deception with the aim of exploiting them.

Tatiana Gren Jardan, Director of Strategy at the Office of the Independent Anti-Slavery Commissioner, discussed the role of local authorities in fighting modern slavery—and how staff may be able to identify cases in their everyday work. Tamara Barnett, from the Human Trafficking Foundation, then outlined the duties professionals have in identifying and supporting victims. Since the passing of the Modern Slavery Act 2015 specified public authorities (including Local Authorities) have a duty to report details of suspected cases of modern slavery to the Home Office. The National Referral Mechanism (NRM) framework can then be used (if an adult victim consents) with offering 45 days ‘reflection and recovery’ time for a victim to receive appropriate support. Continue reading