This case study concerns a service user whom I came to know and deal with during my placement at a day care centre for people who were more than 50 years of age. The service user is an 85 year old lady. She is Christian, white, a British national and speaks English. The service user suffers from diabetes and glaucoma and has developed cataract in the right eye. She has also been suffering from dementia for some time. The service user lives alone in her home but has a small dog for company. She takes care of herself with the support of personal home care attendants. She also uses the services of the day care centre, doctors and nurses, the taxi driver who takes her to the day care centre, and the 2/3 social workers who have been assigned to her. She is prone to falls and has given up leaving her house because of apprehensions about falling and injuring herself. She is also apprehensive about getting dizzy, losing her balance, and falling in the house, especially in the shower. She does not have any friends and has limited contact with the community. She however does have a pendant alarm, which she can use during emergencies, and a telephone. She is however dysphasic, which disturbs her communication with people.
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The service user suffers from dementia, which is getting worse. She has on more than one occasion stated that her carers have stolen her money, her neighbours keep on threatening her, and that somebody keeps on knocking on her door and phoning her. At one time she even stated that her social worker had threatened to send her to prison if she did not hand over the money that was with her. She has also come out on the streets, screaming and crying for help. She used to phone the day care centre repeatedly to enquire about the arrival of her taxi and needed constant reassurance during her low moods.
She is very attached to her handbag and keeps on accusing others of taking her money from it. I interacted with her once at the day care centre when she became extremely upset with another service user, accusing her of taking things out of her bag and complaining that it had too many pockets. She however calmed down after I removed the extra pockets from her bag.
The service user suffers from diabetes and glaucoma and is being provided with appropriate medical care by her GP. She also suffers from dementia, a mental ailment related to ageing that can affect the perceptions of individuals about the world around them. Individuals with dementia often feel that they can hear or see non-existent things or believe something that is untrue (Furay, 2010, p 1). Whilst people suffering from with dementia in the early stages of the disease are usually able to recognise such occurrences as figments of their imagination, they have increasing trouble in distinguishing between reality and fantasy as it gets worse. Individuals with dementia can also experience hallucinations and delusions (Furay, 2010, p 1). Hallucinations represent experiences when people feel, hear, smell, or taste something that is not there. Delusions concern false understandings about present occurrences (Dementia Care Central, 2010, p 1 & 2)). People with dementia might for example believe that their near ones are poisoning them or trying to steal from them (Dementia Care Central, 2010, p 1 & 2). It is thus often frustrating for carers to deal with people suffering from dementia because the disease affects the relationships between them (Dementia Care Central, 2010, p 1 & 2).
The service user came to the day care centre recently to the day care centre in a very scared state and complained about strange men having entered her house. She has since, after being visited by the social worker, being placed in residential care and is expected to stay there until she becomes better. The service user has been coming to the day care centre for four years and 2-3 social workers had been assigned to provide her with appropriate care. Whilst she was being provided with care for her mental health condition in the community care setting, her dementia has worsened and it is felt that she now needs to be kept in a residential setting in order to treat her mental condition and ensure her physical safety.
Section 2: Social Policy and Legislation for the Service User
Social work in the UK broadly functions within the ambit of social policy and appropriate UK legislation (Payne, 2005, p 18). Social workers, mental health professionals, health professionals and other participants of the country’s social and health care system work individually and jointly to further social policy objectives and function within and in accordance with legislative frameworks (Payne, 2005, p 18). Social policy is articulated clearly for different areas of social work and is modified from time to time in line with new developments (Payne, 2005, p 18).
The day care centre where I was placed aimed to help service users above 50 years of age, in living fruitful and productive lives, and in safeguarding them in various ways by providing them with appropriate support in areas of health and social care. The social policy towards Safeguarding of Adults is defined by the National Framework of Standards for Safeguarding Adults (Commission for social…, 2008, p 3). The policy instrument aims to safeguard adults from abuse and neglect that can affect their physical and mental health and wellbeing (Commission for social…, 2008, p 3). It aims to provide appropriate social and health care through multi-agency partnerships between various agencies in areas of social services, housing, education, legal services, medical services, police services and other relevant agencies (Commission for social…, 2008, p 4). Safeguarding of adults includes all types of work or activity that can help in supporting vulnerable adults to retain their independence, their wellbeing and their choice, as also their ability to live life’s free from abuse and neglect (Commission for social…, 2008, p 7).
The Living Well with Dementia strategy, an important social policy outcome that was introduced in 2009 and is relevant for the service user, aims to improve dementia services in three specific areas, namely (a) improvement of awareness, (b) swifter and earlier diagnosis and intervention and (c) better care quality (Department of Health, 2009, p 2). The strategy specifies 17 important objectives that need to be implemented, largely at the local level, for bringing about substantial improvement in the understanding of the reasons and results of dementia, as well as in the quality of services to people suffering from dementia (Department of Health, 2009, p 3).
The safeguarding and care of people like the service user are considered under legislation like the Health and Social Care Act 2008, the Mental Capacity Act 2005, The Mental Care Act 2007, The Disability Discrimination Act 2005 and The Equality Act 2010 (Legislation.gov.uk, 2008, p 2). The Health and Social Care Act 2008 established the Care Quality Commission for regulation and inspection of all health and social care services in England including the services of agencies like the NHS, private companies, voluntary organisations and local authorities, be they in the own homes of service users, residential care homes and hospitals (Legislation.gov.uk, 2008, p 2). The Mental Capacity Act 2005 aims to protect and empower individuals who may not be capable of making some decisions on their own. It also allows people to plan ahead in case of the development of circumstances where they may be unable to take significant decisions about their own selves in future (Mental Health Foundation, 2011, p 2). The act sets out what will happen when people are unable to make specific decisions, and covers different types of decisions like personal finance, medical treatment, social care or even everyday decisions (Mental Health Foundation, 2011, p 2). The Mental Capacity Act however does not cover decisions concerning compulsory detention and treatment for people with medical disorders without their consent (Mental Health Foundation, 2011, p 3).
The Mental Health Act 2007 has amended the Mental Health Act 1983 and the Mental Capacity Act of 2005. It aims to ensure that individuals, with mental disorders of dimensions that can threaten their health and safety or of the public, can be treated regardless of their agreement, where such treatment is essential to restrain them from harming themselves or others (Blaenau-gwent.gov.uk, 2007, p 3). The Mental Health Act 2007 amends the Mental Capacity Act 2005 with regard to procedures for the authorisation of removal of liberty of persons in hospitals or care homes who lack capacity to consent to being there (Blaenau-gwent.gov.uk, 2007, p 3). The Equality Act 2010 develops the provisions of the Disability Discrimination Act to protect individual rights and provide equality to all people (Legislation.gov.uk, 2010, p 1 & 2)).
The details provided in the case study of the service user clearly reveal that she suffers from mental disabilities, (dementia, accompanied by hallucinations and delusions), which prevent her from leading a normal life and taking appropriate care of herself. Being prone to falls and suffering from delusions and hallucinations, she can well harm herself if she is allowed to stay alone in her home. It also does not appear that she is in a position to give rational consent to be treated in a residential care facility. Her care and treatment should thus be organised in line with the social policy for safeguarding adults and with the use of the provisions of the Mental Capacity Act 2005 and The Mental Health Act 2007.
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Contemporary social work policy and practice also calls for the adoption of a person-centred approach, which in turn calls for placing the service user at the core of social work processes and involving her in all assessment processes and obtaining her agreement for planned interventions (Cambridge & Carnaby, 2005, p172). Whilst the Mental Health Act 2007 and the Mental Capacity act do facilitate relevant decision making by professionals when the service user is unable to make a considered decision, such decisions should be made only in accordance with the safeguards mentioned in the acts and careful use of person-centred and anti-discriminatory approaches.
Section 3: Application of Anti-Discriminatory Approach
Anti-discriminatory approach is an integral component of social work practice for the aged, especially for aged people with mental ailments (Carter, 2006, p 2). The theoretical structure for the causes of discrimination is elaborated by Neil Thompson, who states that discrimination basically stems from three specific factors, namely (a) personal, (b) cultural and (c) structural influences (Carter, 2006, p 2). Personal discrimination occurs on account of individual likes and dislikes of people for others. Cultural discrimination, which accounts for the bulk of discriminatory attitudes, arises on account of various cultural and social influences that shape the thinking of people towards others due to issues like age, gender, race, ethnicity, religion, mental health issues and sexuality (Carter, 2006, p 3). Structural discrimination occurs on account of the various ways in which social infrastructures discriminate against members of specific communities in areas of employment and public facilities (Carter, 2006, p 3).
It is essential for social workers dealing with old, ill, and mentally ailing people to understand the implications of discrimination and consciously adopt anti-discriminatory and anti-oppressive approaches. It is not difficult for people to adopt casual and high handed approaches towards old and vulnerable people, who cannot take good care of themselves or others, on account of their age and their physical and mental frailties. It is also easy in such circumstances to forget or overlook the fact that such people have in the past lived long and fruitful lives, wherein they have fulfilled their personal, family, social, cultural and workplace obligations, and contributed significantly to society and to the people around them.
It is even more simple to adopt discriminatory attitudes towards the mentally ailing, who are very clearly unable to take decisions for their own selves and do not appear to be normal in the usual sense of the world (Pugh, 2009, p 284). Mentally ailing people have been subjected to discrimination and ridicule down the ages and such discriminatory attitudes are constantly reinforced through literature, text and various types of social interaction (Pugh, 2009, p 284).
My knowledge and reading of anti-discrimination practice informs me of the importance for social workers and mental health professionals to approach the problems of the aged and of physically and mentally ailing people, like the service user, with very firmly adopted anti-discriminatory approaches and to consider them as individuals who have their specific needs, likes and dislikes and have not only lived productive lives but also contributed significantly to society.
Section 4: Evaluation
My reading of social work policy and legislation for ageing and/or physically and mentally ailing people has helped me in informing and improving my practice in various ways. Old, infirm, and mentally ailing people need to be safeguarded with care and compassion through well developed policies and appropriately implemented practices. Social and health care policies and practices, in such circumstances, are required to address the issue of independence vis-Ã -vis risk and safety concerns. The personalisation policy, which is expected to come into the mainstream by 2013, will help service users to become more independent. The policy requires social care agencies and professionals to assist and support people in selecting their preferred care, thus enabling them to take on everyday risks, like the rest of society and maximising their independence from outside interference (Gardner, 2010, p 2). Such personalisation will mean that universal services, like housing, transport, and education will become accessible to everybody are accessible to all citizens (Gardner, 2010, p 2). Social work approaches regarding early intervention and prevention will also have to be developed further in order to encourage people to stay healthy and independent (Gardner, 2010, p 2).
Whilst modern day social work policy, theory and practice recommends the furtherance of independence of service users and the provisioning of social and health care in their homes and community care settings, the need for providing care in residential care environments may arise in circumstances where the failure to do so can result in harm to the service user or to others. Social workers, in consultation with other experts, must, in such circumstances assess the conditions of service users, and might subsequently have to take decisions to remove individuals from day care settings and place them in residential care settings. Such decisions, whilst restricting the independence of service users, becomes essential to safeguard their mental and physical health and to protect them from harm.
Assessment and decision making in interventions in such circumstances must be made very carefully with the firm use of anti-discriminatory approaches and the use of person-centred practice. Person-centred practice calls for placing service users at the core of the social work process, involving them in the assessment and obtaining their agreement to the intervention plans. Whilst such options may not be available where individuals are not able to contribute effectively to decisions, social workers should take great care to ensure justice and ensure absence of oppression.
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