Vulnerable Adults, Mental Capacity and Social Care Refusal

Keywood, Kirsty

doi:10.1093/medlaw/fwq001

Cited by 11 publications

(9 citation statements)

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“…Keywood (2003, p358) refers to "the law's recognition of the pre-eminence of autonomy as the appropriate moral foundation for individual agency and responsibility". The statutory presumption of capacity within the Mental Capacity Act 2005 (MCA) -whereby a person must be assumed to have capacity unless it is established (through capacity assessment) that they do not (s.1(2)) -has powerful ethical as well as legal force (Keywood, 2010;Twomey, 2015). When linked with the further statutory principle (section 1(4)) that a person is not to be treated as unable to make a decision merely because they make an unwise decision, it lends considerable support to individual decision-making autonomy.…”

Section: The Privileging Of Autonomymentioning

confidence: 99%

Autonomy and Protection in Self-neglect Work: The Ethical Complexity of Decision-making

Braye

Orr

Preston‐Shoot

2017

Ethics and Social Welfare

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Section: The Privileging Of Autonomymentioning

confidence: 99%

Autonomy and Protection in Self-neglect Work: The Ethical Complexity of Decision-making

Braye

Orr

Preston‐Shoot

2017

Ethics and Social Welfare

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“…Certainly, working with adults who self-neglect is demanding and staff qualifications, experience and training may have proved insufficient; equally thresholds for involvement, particularly of an on-going nature in the light of service refusal, may have been set too high or applied too rigidly because of funding constraints (Manthorpe and Martineau, 2013;Braye et al, 2014). The emphasis on personalisation and the assumption of mental capacity may have influenced how practitioners approach questions of choice and lifestyle (Keywood, 2010). Faced with hostility, intransigence, resistance and aggression, agency responses may have come to mirror the same behaviour.…”

Section: Concluding Discussionmentioning

confidence: 99%

Serious case review findings on the challenges of self-neglect: indicators for good practice

Braye

Orr

Preston‐Shoot

2015

The Journal of Adult Protection

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Purpose – The purpose of this paper is to analyse in detail the findings from 40 serious case reviews (SCRs) involving adults who self-neglect, and to consider the commissioning and reporting of such inquiries in the context of accountability that also involves the Coroner and the Local Government Ombudsman. Design/methodology/approach – This study comprised a cross-case analysis of 32 SCRs, using a four-layer design of the adult and their living context, the team around the adult, the organisations around the team, and the Local Safeguarding Board around the organisations. Findings – Available reports tend towards description of events rather than appraisal of what influenced practice. They highlight the challenges in cases of self-neglect practice, including person-centred approaches, capacity assessment and securing engagement. Familiar themes emerge when the spotlight turns to professional and organisational networks, namely information-sharing, supervision, recording and compliance with procedures and legal rules. Some Local Safeguarding Adults Boards found the process of conducting and then using serious case reviews for service improvement challenging. Research limitations/implications – The cross-case approach to thematic analysis focuses on reports into situations where outcomes of professional and organisational intervention had been disappointing. Nonetheless, the themes derived from this analysis are similar to other research findings on what represents best practice when working with cases involving self-neglect. Practical implications – The paper identifies learning for the effective commissioning and conduct of SCRs, and for service improvement with respect to practice with adults who self-neglect. Originality/value – The paper offers further detailed analysis of a large sample of SCRs that builds the evidence-base for effective practice with adults who self-neglect and for efficient management of process of commissioning and conducting SCRs.

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“…It warrants considerable guidance to social care staff in particular, and extends into debates about self-neglect and service refusal (Scourfield, 2010;Keywood, 2010) that have been the focus of recent literature and several high profile serious case reviews. The guidance needs to address the way concerns are formulated offering examples of how inter-related issues can be organised into a hierarchy and showing what ''level'' of decision should be the focus, debating whether a number of difficulties should be bundled up into one ''matter'' to be deliberated by professionals or brought before the court.…”

Section: Discussionmentioning

confidence: 99%

Using the Mental Capacity Act in complex cases

Brown

Marchant

2013

Tizard Learning Disability Rev

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Purpose -The purpose of this paper is to explore the way that practitioners apply the 2005 Mental Capacity Act (MCA) in complex cases involving people with learning disabilities who cannot make some key decisions by themselves. Like many qualitative studies it began with a felt sense that practitioners were struggling to apply the clear framework set out in the Act to real life situations, and that some of the decisions they were faced with did not fit neatly into the linear, cognitive model of decision making set out in the MCA and its accompanying guidance.Design/methodology/approach -The study was conducted under the aegis of the Office of the Public Guardian (OPG) during 2010-2011. A number of ''complex'' cases were obtained from Social Services, Primary Care Trusts and other organisations and subjected to thematic analysis. The current paper focuses on the 16 cases that involved people with learning disabilities.Findings -A number of issues were identified that underlay the complexity of the cases examined. The cases drew attention, in particular, to the way in which practitioners were confronted with mounting concerns as opposed to single, discrete decisions, with the risk that decisions could be delayed until positive choices were much less available.Originality/value -The aim of the study was to support the use of the Act in these situations and to give practitioners confidence in applying its principles across a wide range of diverse circumstances. Although the original study specifically related to the English legislation, the factors that led people to consider a case ''complex'' would apply equally in other jurisdictions. The study also shed light on difficulties that arise when intervening in less formal ways.

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Vulnerable Adults, Mental Capacity and Social Care Refusal

Cited by 11 publications

References 0 publications

Autonomy and Protection in Self-neglect Work: The Ethical Complexity of Decision-making

Autonomy and Protection in Self-neglect Work: The Ethical Complexity of Decision-making

Serious case review findings on the challenges of self-neglect: indicators for good practice

Using the Mental Capacity Act in complex cases

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