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Commentary on “The bounds of liberty: lessons learnt from treating a man with alcohol use disorder, autism and learning disability”
- Author:
- BROWN Hilary
- Journal article citation:
- Tizard Learning Disability Review, 23(1), 2018, pp.35-41.
- Publisher:
- Emerald
Purpose: In commenting on the issues raised by Drake et al. the purpose of this paper is to discuss three areas of practice: assessing capacity in the presence of intransigence and/or rigid patterns of thinking and behaviour; understanding addiction in this context; and identifying “reasonable adjustments” in the way addiction and substance misuse services are provided to this client group. Design/methodology/approach: As well as discussing the issues raised by Drake et al. the commentary refers to a serious case review exploring similar issues. Findings: Both the case discussed by Drake et al. and the serious case review draw attention to the importance of identifying “reasonable adjustments” to current practice. Research limitations/implications: While the implications of the cases discussed are very significant, further work quantifying the scope of the problems identified would be very useful. Practical implications: The 1995 Disability Discrimination Act (UK) requires public services to make “reasonable adjustments” in order for people with a range of disabilities to access their services on an equitable basis. This paper identifies what some of those areas of difficulty might be. Originality/value: This is a relatively new area of work and expertise in both mainstream addiction and specialist intellectual disability and mental health services needs to be developed in order for them to provide more coherent and accessible programmes to individuals. (Publisher abstract)
Commentary on “The effectiveness of psychodynamic interventions for people with learning disabilities: a systematic review”
- Author:
- BROWN Hilary
- Journal article citation:
- Tizard Learning Disability Review, 19(1), 2014, pp.25-28.
- Publisher:
- Emerald
Purpose: This paper is a commentary on “The effectiveness of psychodynamic interventions for people with learning disabilities: a systematic review” by Chris James and James Stacey. The purpose of this paper is to illustrate the thesis that standardised ways of evaluating health care interventions may have the inadvertent effect of undermining the case that people with intellectual disabilities should be offered the same opportunities to address their emotional and mental health difficulties as other citizens. Design/methodology/approach: The commentary argues that while the evidence base focuses on the outcomes of orthodox one-to-one interventions, sometimes broader “contextual reformulation” and systemic interventions are called for. However, family- or service-based interventions tend not to feature in studies. Findings: The commentary illustrates these issues by discussing two case studies, which demonstrate how relational issues tend to be unhelpfully focused on the person with intellectual disabilities to the detriment of family members or direct care staff, who may be struggling to make sense of the person's behaviour or distress. Originality/value: The commentary supports the argument put forward in the longer paper and also argues for mental health services to be offered on a non-discriminatory basis to people with intellectual disabilities and to their family members. But it also suggests that one of the additional impacts of service level psychotherapeutic interventions is to re-establish respect for the work of direct care staff whose work is often presented as if it is little more than domestic drudgery when in fact it involves negotiating and responding to people and their issues with great sensitivity and balance. (Publisher abstract)
Using the Mental Capacity Act in complex cases
- Authors:
- BROWN Hilary, MARCHANT Liz
- Journal article citation:
- Tizard Learning Disability Review, 18(2), 2013, pp.60-69.
- Publisher:
- Emerald
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. (Publisher abstract)
Not only a crime but a tragedy [...] exploring the murder of adults with disabilities by their parents
- Author:
- BROWN Hilary
- Journal article citation:
- Journal of Adult Protection, 14(1), 2012, pp.6-21.
- Publisher:
- Emerald
The author considers what can be learned from the occasional cases in which the parents of disabled adults kill their sons and daughters. She seeks to reconcile society's need to apply strong sanctions to the parents while also recognising the stresses in their lives. Six cases are reviewed in detail. These involved seven disabled adults killed by a parent in the UK between 1999 and 2009. Every case involved the mother. Their actions did not appear to be motivated by malice, but occurred against a backdrop of significant mental illness and distress. Two of the parents killed themselves as well as their adult child and another attempted suicide. The explanations offered in court included a combination of caregiver stress and mercy killing. The author suggests that the judicial system is struggling to find a consistent approach. Study limitations are noted. Only high profile cases reported in the press are included, these represent a subset of all cases in the study period. Only information in the public domain is included; the portrayal of the issues in the media is integral to the study. The author concludes with recommendations as to how the backdrop of significant mental ill-health could be taken into account in the way families are offered support with a view to preventing further tragedies.
The role of emotion in decision-making
- Author:
- BROWN Hilary
- Journal article citation:
- Journal of Adult Protection, 13(4), 2011, pp.194-202.
- Publisher:
- Emerald
This paper draws on research pointing to the contribution of emotions and mood in determining the outcome of decision making. It aims to challenge the rational model of decision-making upon which the Mental Capacity Act (MCA) 2005 is premised. The paper forms part of a larger study commissioned by the Office of the Public Guardian to explore decision making in complex cases. This review considers the role of the following factors in decision making: history and memories; motivation and drive; mood and stability; and openness to influence. The findings supports the theory that decisions are not made in a linear way. This view of how we make decisions will enable practitioners to make more nuanced assessments of a vulnerable person’s mental capacity, especially in the context of self-neglect. It should help to alert them to situations where vulnerable people are out of their depth; when the role of depression and anxiety may be at least as salient as their understanding of possible consequences and when the past may exert more control over their actions than their understanding of future options.
The process and function of serious case review
- Author:
- BROWN Hilary
- Journal article citation:
- Journal of Adult Protection, 11(1), February 2009, pp.38-50.
- Publisher:
- Emerald
The author summarise the processes Kent have put in place for the referral and conduct of serious case reviews in adult protection, and what they have learnt from the reviews they have undertaken to date. The author writes as the independent chair of the Serious Case Review Panel, and an occasional chair of one-off inquiries for other authorities.
A rights-based approach to abuse of women with learning disabilities
- Author:
- BROWN Hilary
- Journal article citation:
- Tizard Learning Disability Review, 9(4), October 2004, pp.41-44.
- Publisher:
- Emerald
Provides a brief overview of abuse and protection with particular focus on women with learning disabilities, who face double oppression as the intersection of gender and disability making them particularly vulnerable to sexual violence and exploitation. Reviews some useful models of abuse, to guide practice and frame further research, and reflects the Department of Health guidance No secrets (2000), which has resulted in a coherent framework for use throughout local authorities and other statutory agencies to address abuse against all vulnerable adults.
Suspected financial abuse among cases administered by the PGO
- Authors:
- BROWN Hilary, BURNS Sophie, WILSON Barry
- Journal article citation:
- Journal of Adult Protection, 5(2), May 2003, pp.26-37.
- Publisher:
- Emerald
The risk of financial abuse is a major concern for the Public Guardianship Office (PGO) in England and Wales and the Court of Protection. This article reports on a study analysing case files identified by Public Guardianship Office staff as those in which abuse was a strong possibility. Presents summaries of some of the cases. Analysis of the cases suggested that a more proactive system of risk management could be developed. Three interacting risk domains were highlighted: the person's vulnerability; the character/intention of the person's representative; and the financial arrangements in place.
Links between the Public Guardianship Office and social services departments
- Authors:
- WILSON Barry, BURNS Sophie, BROWN Hilary
- Journal article citation:
- Journal of Adult Protection, 5(2), May 2003, pp.38-46.
- Publisher:
- Emerald
This article explores the links between the Public Guardianship Office and social services in relation to abuse and to local authority management of the finances of vulnerable people. Reports on the results of a study examining the operation of local authority receivership units through interviews and visits. Also reports on a small-scale study of adult protection co-ordinators in social services departments, which explored the nature and contact between the two agencies in the context of adult protection inquiries.
What is financial abuse?
- Author:
- BROWN Hilary
- Journal article citation:
- Journal of Adult Protection, 5(2), May 2003, pp.3-10.
- Publisher:
- Emerald
The author explores the meaning of the term 'adult abuse' and suggests new ways of looking at the phenomenon. The article brings together the literature on both financial abuse and neglect, focusing in particular on the interaction between financial abuse and neglect in the context of adults who lack capacity.