SAR Finley - learning briefing
Background
This review looks into the death of a man in his 30s who died from a drug overdose.
When Finley was 16, he was detained under Section 2 of the Mental Health Act (MHA). He was suffering from psychosis which appeared to be drug-induced. He was diagnosed with schizophrenia and spent about two years in an adolescent unit.
At 19, Finley was placed in supported housing. This lasted for several years before he moved to private housing.
Finley had a number of inpatient admissions, usually detained under the MHA, due to not taking his medication as prescribed.
He used illicit drugs over a long period of time and continued to do so until his death.
Neighbours complained about the condition of the front garden and rubbish bins. Reports suggested that he may be subject to cuckooing as items had gone missing from his flat.
There was clear evidence from agencies that he was unable to live well independently with obvious signs of self-neglect.
Finley’s mother held lasting power of attorney for both property and finance and health.
Key findings
Responding to indicators of cuckooing
In Finley’s case, no specific evidence was found to support the suspicion that he might be at risk from cuckooing. But there were indicators of County Lines and previous concerns about cuckooing of someone Finley knew.
Although agencies shared some information, there was not a safeguarding enquiry. Assumptions were made about the groups of young people visiting Finley, despite the concerns raised by the local community.
Dual diagnosis
Finley was known to be a long-term drug user but declined any support. When he was detained in hospital, there were missed opportunities to attempt to find ways to work with him.
The review highlighted the importance of integrated assessments and support planning. These support hospital discharges for people with both mental health problems and problematic use of substances.
Multi-agency response to self-neglect
Finley was known to neglect himself, especially when he wasn't taking his medication or was in a mental health crisis.
He was considered to have the mental capacity to make decisions about his care and support needs. This meant that he was able to hide his drug use from professionals.
When someone has mental health issues, is struggling with substance misuse, and refuses help, agencies should follow the self-neglect procedures within the Sussex Safeguarding Procedures.
It is important that professionals understand that the Mental Capacity Act does not stop them from acting to protect someone from self-neglect.
Direct work with the individual and carers
Finley’s mother had power of attorney (POA).
When someone's ability to make decision fluctuates, as in Finley’s case, it is important to involve their attorney at every point. This way they understand any changes to the individual’s health and treatment.
Missing appointments or misusing substances might show a loss of capacity and self-neglect.
If the individual doesn't want their attorney always being involved, explore their wishes and the dynamics of the relationship.
Good practice and key learning
Finley’s mother thinks some people were really good at building a relationship with him. She especially liked the Tenancy Resolution Officer, who always tried to help Finley, and the Child and Adolescent Mental Health Service worker, who kept working with Finley even after he turned 21.
The Tenancy Officer and Tenancy Resolution Officer worked hard to keep Finley housed. They also responded quickly to the complaints from Finley's neighbours.
Despite the Covid-19 pandemic restrictions, agencies maintained their efforts to undertake home visits to Finley.
When Finley left the hospital, he didn't want any help. But there were joint visits by the Tenancy Resolution Officer, Community Psychiatric Nurse and Social Worker. This helped keep Finley connected to the services that could help him.
Self-neglect: What are the signs and causes?
Self-neglect is when someone can't (or doesn't) take care of themselves in a way that's considered safe and healthy. This can lead to serious problems for them and even for the people around them.
Under the Sussex safeguarding adults policy and procedures, whether or not we need to step in and help someone who's self-neglecting depends on if they can keep themselves safe. Sometimes, people might need help to do this.
Supporting someone with fluctuating capacity is a complex process. We need to think about if they can understand things and make decisions, but also if they can actually do what they decide.
If you think someone might be self-neglecting and nothing is being done, things can get worse. This could lead to serious problems for that person.
Lasting power of attorney (LPA)
Health and welfare
If someone has a health LPA, this should show what they've agreed to with their attorney.
To have an LPA, a person must be mentally capable when they appoint their attorney. This way, they can decide what they want to happen if they can't make decisions later on.
The health and welfare LPA is only used when the person can't make their own decisions. The attorney can then decide things like what the person eats, where they live, and what medical care they receive.
Property and finance
The property and finance LPA is for supporting an individual (donor) to make decisions about issues such as money, tax, bills, and benefits.
If the LPA states that the person gives permission, the attorney can start making decisions while the person still has mental capacity.
- How do you incorporate lasting power of attorney arrangements for property and finance and health and welfare into a person's care, treatment, and support plan?
- Factsheet FS 22: Arranging for someone to make decisions on your behalf | Age UK
Responding to suspected cuckooing
Cuckooing is the practice of taking over the home of a vulnerable person to establish a base for illegal activity. Gangs exploit, threaten and manipulate victims. The gangs then use their homes for drug dealing or other criminal activity, such as sexual exploitation.
- Question: What evidence could indicate someone is being cuckooed or at risk of being cuckooed?
- Cuckooing: using people's homes for crime | Safe in East Sussex
Further reading and resources
- SAR Finley report
- Mental capacity multi-agency policy and procedures
- Sussex multi-agency procedures to support adults who self-neglect
- Severe mental illness and substance misuse | NICE
- What is a Dual Diagnosis in Mental Health? | Family First Intervention (2:24 mins)
- Safeguarding adults thresholds guidance
Training
East Sussex Learning Portal offers multi-agency safeguarding courses. These include self-neglect, trauma-informed practice and Mental Capacity Act training.
