Safeguarding highly vulnerable, chronic, dependent drinkers: case example

This statement by the relatives of Simon was submitted to the Coroner who was looking into the circumstances surrounding his death. This is a tragic example of what can happen when legal powers, assertive outreach and multi-agency groups are not properly utilised to help a highly vulnerable, chronic, dependent drinker.

Simon, aged 53, was a shy, philosophical, untidy, gentle man who lived alone. In his spare time, he was an avid reader who listened to music and enjoyed astronomy and cooking. He was a softly spoken intelligent eccentric who was slightly unconventional, non-conformist and unorthodox. He was a proud and private man who never asked for anything. He was a hard-working, conscientious and reliable worker until a fit in 2015 prevented him from operating machinery and resulted in him losing his job.

For the first time, he was thrown into a world of form filling and computers where he struggled to cope with getting income support, managing his bills and taking care of his health, himself and his home. Simon got caught in the following loop that seemed to be stuck on “replay” for the years prior to his death.

We appreciate this is a highly complex issue that spans multi-disciplines, however, could any changes be made to prevent this happening again?

A summary of the last few years of our brother’s life and the interaction he had with various agencies follows (our thoughts and questions are highlighted in bold italic):

Despite multi-referrals from hospitals, ambulance, fire, police, neighbours and family regarding serious self-neglect, hoarding, non-existent hygiene, filthy living conditions, no heating, no appliances, social isolation, chaotic lifestyle, alcoholism and epilepsy our 53 year old brother Simon died alone in squalor. Simon was a known vulnerable adult who had mental capacity to make decisions about his support/living arrangements but under the current rules he was allowed to choose not to engage with offers of support.

We want to prevent this happening again for the sake of people like Simon and the profound unintended impact on their family or community.

Simon underwent a tortuous six year ordeal involving 20 visits by ambulance to hospital, six police incidents and six fire brigade incidents resulting in six social services referrals that all resulted in a closure due to lack of engagement.

The framework that prevents power or authority to impose support should be amended to trigger mandatory intervention if referrals are made 3 times from any agency.

A deprivation of liberty led to a medically assisted detox, however, as soon as a mental capacity assessment was passed, he was released from hospital.

Could those powers be extended to cover after hospital social care? Is the mental capacity assessment suitable for people with alcohol dependency?

The social workers were kind to Simon; however, they were general social workers, not experts in self neglect, hoarding or alcohol. Had the social worker skills been matched to Simon’s issues/needs perhaps he could have been persuaded to receive the help he so desperately needed.

The referrals always seemed to go to Social Care. Was that the right place? If so, social worker skills need matching to their cases.

Simon was lucky to have a volunteer visitor from a charity who successfully built a relationship of friendship with him. Social services decided to ride on that established friendship with Simon as a way of engaging him. However, asking a friendship volunteer to get involved in DWP paperwork and social worker duties overloaded the volunteer so she stopped seeing Simon and Social Services were no further forward in building a relationship of their own with Simon.

With hindsight we would have preferred the volunteer visits to continue as they made a perceivable difference to Simon’s happiness and well-being.

Simon was sectioned at hospital X where he was described as a “gentle soul”. He positively engaged fully with the staff, remaining under his own free will. The reason for transferring Simon to mental health unit Y was to be closer to home in order to sort out the house while still receiving medical support. This hospital transfer went wrong, permitting Simon to discharge himself within hours.

We feel that future hospital transfers should re-start the sectioning clock to give a patient time to adjust to the new hospital environment and if there are noted concerns about living conditions (as was the case here) these MUST be addressed prior to permitting discharge.

What were the differences in approach that worked in hospital X and failed in unit Y? Can any lessons be learnt and carried forward?

Social services’ first and primary focus was sorting out finances which under normal circumstances we agree with because money leads to food and warmth. However, someone who is alcohol dependent isn’t interested in food and warmth, so something needs to change in their social care. Undeniably universal credit back payments caused a significant deterioration in Simon’s health.

A change is needed to dovetail any finances with professional help with alcohol dependency in a timely and co-ordinated fashion. On-going support is also needed to ensure living standards are being maintained and cases should not be closed until demonstrable evidence exists to prove that whatever caused the referral has been 100% complete.

Simon’s alcohol treatment changed from service A to service B. Service A did reach out into people’s homes, yet service B relied solely on someone asking for help. People who are alcohol dependent may be private or shy.

If they won’t reach out, someone needs to reach in.

Drug and alcohol services and social services changed staff multiple times meaning that rapport was impossible to develop. This frequent change in personnel can’t be beneficial to shy, private individuals who desperately need help.

Resourcing needs to be consistent.

In innocence and in desperation we asked for psychiatric professional help only to be told a referral would not be possible due to Simon’s alcohol dependency. In truth we knew we needed professional help BUT we didn’t know where that help could be provided. We were spun around hospitals, doctors, social services, mental health and alcohol services all to no avail.

Years of burning a hole in Google search engines failed to pin-point a plan of action. With hindsight there were no experts, or if there were, they were not easily available, leaving us to deal with an unascertained death. It isn’t good enough to bounce an ill person and their family round all these agencies without anyone responsible for putting all the bits of the jigsaw together, getting a plan of action and then actioning that plan. 131 emails and over 300 telephone conversations to hospitals, doctors, social services, mental health, and alcohol services miserably failed to help Simon.

If someone has chronic alcohol dependency there should be a multi-disciplinary team all working together; and professionals in alcohol treatment should remain on the case.

There were brief moments of opportunity when Simon was in the right frame of mind to be receptive to the idea of treatment in November 2018 and March 2020. On both occasions following hospitalisation, the after-care at home just wasn’t there so the opportunity to help was lost.

We certainly do not want to apportion blame because all the parties involved tried with kindness, however, we do want lessons to be learnt and addressed going forward.

If alcohol dependency is a mental illness, then why is the harmful use of alcohol and alcohol dependency excluded from the Mental Health Act? And why can’t the Mental Health Act be used as a reason for detention in order to prevent death?