I came across this story yesterday which was published in the Rye and Battle Observer about a 92 year old man who hanged himself because he was unable to cope at home and had been told he might not be placed in a residential home although he had asked to.
I have to say honestly, I probably wouldn’t have done anything differently from the social worker in the story. Mr G lived alone. He began to feel that he was unable to manage at home. His niece calls social services on a Friday afternoon telling them he needs to be placed in residential care immediately. Immediately is a difficult word for a Friday afternoon. I know because I’ve been there – taking those telephone calls.
The social worker tells her that there are criteria that need to be met and she can’t guarantee an immediate placement. OK, that sounds like a scenario I’ve been in a number of times. We have very poor access to immediate placements now either permanent or respite. This is for a good reason. The CSCI expects (quite rightly) that a residential facility assesses a potential resident prior to agreeing to admission. Same day placements were always very rare but they are now much rarer than they were. Even last week, I had to admit someone who was suffering from domestic violence to our wards because we couldn’t find a placement for her in an emergency (she agreed by the way!).
Mr G packs over the weekend getting ready for his ‘move’ on Monday. Social worker phones him and his niece to confirm the assessment and emphasise that it may not result in an immediate placement. Again, phone before you leave the office to confirm – don’t raise expectations – look at all options and use residential as a course of last resort. That’s what we do. Residential care is expensive.
Between that telephone call and the afternoon when the niece visited, Mr Godwin hanged himself.
Tragic.
The inquest reported that social services could have offered respite care.
His niece is furious – blaming social services for not intervening sooner.
The social worker’s defence
it was her professional duty to be clear and transparent and said she did not believe Mr Godwin would have qualified for residential care, his need being ’substantial’ rather than ‘critical’.
And you know, I would have done exactly the same thing as her under the circumstances. Residential places are scarce – immediate placements particularly. But it’s hard to make the call sometimes. For me, it’s a very tragic and unfortunate lesson to be learnt in risk and risk assessment.
I know there’s a need to place blame and I feel for that social worker because it really truly could have been me. Mr G apparently (or at least it isn’t made clear from the article) had never mentioned depressive feelings or suicidal intents before that weekend. Although he could have been having those feelings without telling anyone.
Sometimes there are tragedies that can’t be foreseen. Although it’s always easier with hindsight.
Filed under: carer, long-term care, old age, older people, social care, social work, work | Tagged: Commission for Social Care Inspection, csci, health, long-term care, respite care, risk, risk assessment, social work, United Kingdom
Inasmuch as we believe clients should be entitled and empowered to be their own human beings, there must always be things we cannot control, including risks that become lethal. Hindsight is twenty-twenty, and it is often made most clear by friends and relatives who believe social workers should have stepped in and taken all control from the self-destructive client.
Last year our agency reviewed a case we had served where children were improperly supervised because their mother had severe mental health issues. Things looked safe when we closed out; we had thorough safety plans around supervision, including lots of supportive baby-sitters. Then, a year after we were involved, the children were found dead in a neighbor’s swimming pool. Things had deteriorated substantially and the very young children went wandering. As a team we reviewed the case, and still agreed that based on our knowledge at the time, the intervention seemed appropriate. We felt sick for the children, but could not imagine much in the way of improvement for the intervention.
As long as we value human independence, which we must, some clients will make tragic choices or otherwise wind up in horrible situations. Even if we act with utmost professional competence in these situations, the frustration is that certain non-social workers will always believe we’ve dropped the ball. And worst of all, in the U.S., we can always get sued for it.
You’ve both said it: It’s the human element. We ultimately have no control over that.
That’s tragic, BJ – but it’s true that you can only go so far. That’s what risk assessment is all about. With all the tools in the world, it’s still about having the right to manage risk.
I guess we all would find some benefit from a retroscope! I think risk assessment is an often used phrase, often used with little understanding. I think there is a general perception that risk assessment (and carrying one out) somehow negates risk. This perception is perhaps reinforced by policies put in place in large, often state run, organisations. Ergo a risk assessment has been done so there is no risk. Risk assessment is about reducing risk wherever possible and there is a risk with most things. In the tragic case above I would speculate the risk was not apparent.
That is such a sad story, I feel angry for the man feeling so desperate that he killed himself, and angry that they left it until a friay afternoon to do anything. I wouldnt want your job the decisions you make on a day to day basis about clinical decisions would be too hard. X
Risk is a funny thing. We are by our nature very risk averse. And sometimes they are just paper exercises that seem to achieve very little. I think my point was trying to be that risk can’t always be ‘assessed’.
And sometimes you just try not to think about it too much. CM.