Self Neglect - PowerPoint Presentation

Slide1

Self Neglect and the Mental Capacity ActSlide2

Safeguarding AdultsLocal Authorities

have a duty to make, or cause to be made, enquiries in cases where they reasonably suspect that an adult with care and support needs is experiencing, or is at risk of, abuse or neglect, and, as a result of those needs, is unable to protect themselves from this actual or risk of abuse and

neglect (Care Act S.42)

The objective of a Safeguarding Adults Board is to help and protect adults in its area (Care Act, S.43)Slide3

The Six Safeguarding Principles

Empowerment

:

people being supported and encouraged to make their own decisions and give informed consent

Prevention: it is better to take action before harm occurs

Proportionality: the least intrusive response appropriate to the risk presented

Protection:

support and representation for those in greatest need

Partnership: local solutions through services working with their communities – communities have a part to play in preventing, detecting and reporting neglect and abuse

Accountability

and transparency in safeguarding practice Slide4

The Mental Capacity ActAbout empowerment and protecting people from unwarranted intrusion into their private lives

Underpinning ethos that adults

s

hould be free to live their lives in the way that they choose wherever possible – however unwise we think they might be – and to be supported in making their own decisions

However, also there to protect those people who are unable to make decisions for themselves and to provide a decision making framework that works for the individual’s best interestsSlide5

5 PrinciplesAssumption of capacity

Obligation to give all reasonable assistance to make our own decisions

Unwise decisions do not equate to a lack of capacity

All decisions made on an incapacitated person’s behalf must be in their best interests

Always look for less restrictive interventionsSlide6

Independence v Protectionrespect for autonomy

v

neglect

House of Lords committee in 2014

c

ritical of ‘prevailing professional cultures of risk aversion & paternalism that inhibit the aspiration of empowerment’

critical of how the presumption of capacity is sometimes used to avoid difficult situations and can be used to support non-intervention in situations where vulnerable adults are then exposed to harm

Self-neglect & hoarding often poses particularly difficult challenges in getting the balance rightSlide7

Whose Interests?Often competing interests and pressures to intervene

Neighbours

Family

Professionals

MediaSlide8

Mental Capacity ActDoesn’t give answers to very complex questions about what to do

Does provide a framework within which to wrestle with dilemmas

Does provide a legal basis for decisions about how to intervene (or whether to intervene at all)Slide9

Legal Basis for Action

Agencies must have a legal basis for intervening in someone’s life

‘The

ordinary powers of a local authority are limited to investigating, providing support services, and where appropriate referring the matter to the court. If a local authority seeks to regulate, control, compel, restrain, confine or coerce it must, except in an emergency, point to specific statutory authority for what it is doing or else obtain the appropriate sanction of the

court’ (Judge Peter Jackson)

Informed consent (with capacity)

Mental Capacity Act (without capacity) – including the Court of Protection

Other legislation if appropriate

Mental Health Act

Environmental Health

Housing legislation

Police powersSlide10

Mental Health Act(regardless of the person’s capacity)

S2/S3/S4 – detention in hospital (no power of entry)

S115 – right to enter & inspect any premises (other than a hospital) in which a mentally disordered patient is living, if he has reasonable cause to believe that the patient is not under proper care (no power of entry), but refusal is an offence under S129

S135 – warrant to gain access to a property and, if thought fit, remove the person to a place of safety with a view top making an application under the Act or making other arrangements for his treatment or care

Only if there is reasonable cause to suspect the person is suffering from mental disorder &, if living alone, is unable to care for himselfSlide11

Police Power of Entry S17(e)Police and Criminal Evidence Act

A constable in uniform may enter and search any premises for the purpose of saving life or limb or preventing serious damage to property.

(common law power of entry to deal with or prevent a breach of the peace

)

Can only be used in situations of immediate risk of harmSlide12

Assessing CapacityStandard test of capacity

Impairment of or disturbance in the functioning of the mind or brain prevents the person making a decision

Understand relevant information

Retain information

Use & weigh information to come to a conclusion

Communicate that decisionSlide13

Impairment or Disturbance in the functioning of the mind or brainThere must be one for the person to lack capacity

Not necessarily a formal diagnosis

M

ust have a reasonable belief that it is there

Be clear what the evidence is

Causal Nexus

The inability to make a decision must be caused by the impairment/disturbance

Be clear what the link isSlide14

Decisional v Executive CapacityOften an issue with people who self neglect

Situations where a person seems to agree something needs doing but is unable to implement the actions necessary

Interesting discussion to be had, as the MCA test doesn’t mention ability to put decisions into practice

BUT the person’s ability to appreciate the difficulties they have with acting must be part of the capacity assessment

Usually relevant in the understanding & using and weighing aspectsSlide15

What if someone doesn’t want to engage in an assessment?

Take your time

Be creative in how you gather evidence

Share the responsibility

Ultimately, the decision simply has to be reasonable, even if based on less information than is ideal

Refusal to participate may indicate a lack of capacity (but be careful!)

Wandsworth

CCG v IA and TA  

[2014] EWHC 990 (COP)

Slide16

Person With Capacity

MCA has no jurisdiction and intervention using it is not possible

Look at other legal avenues for action

Even if no action is possible, still need a plan to address situation

Record carefully – including plans for reassessmentSlide17

Person Lacking CapacityBest Interests Decisions enable actions to be taken without the person’s consent

Check for LPA or Deputy with authority to give consent

Follow usual B.I process to decide on best way

forward

Don’t Forget:

Person’s wishes, feelings & beliefs are still important

Be clear about probable impact of interventions

Doesn’t give carte blanche to do whatever we want!

Significant intervention may need an application to the Court of ProtectionSlide18

Key Points in Best Interestsi

nvolve the person as much as possible

Consult widely (IMCA or other advocacy?)

b

e clear about the options being offered

e

vidence based decision-making

u

se the balance sheet approach to highlight the pros & cons

highlight issues of ‘magnetic importance’

r

ecord carefully

r

eviewSlide19

(the MCA) is sometimes used to support non-intervention or poor care, leaving vulnerable adults exposed to risk of

harm

(House of Lords Scrutiny Committee, 2014)

‘What’s the point of making someone safer if all we do is make them miserable?’

(Sir James

Munby

)