How difficult is it to have somebody sectioned?

[Aroundandaroundagain3]

I've posted on here a few times over the years about the problems surrounding my DM's alcoholism and the distress it was causing me trying to get her to engage with help. I finally took the majority advice and went NC had I've a blissfully stress free 6 months until today.

I had a call from the warden at her over 50's housing complex who does her best to support her, she said DM has gone downhill massively. She's not eating, spending all of her money on drink, has been incontinent, is in a right state with her appearance and hygiene and has had more falls. She has been going to other residents for help but refusing to engage with paramedics. Warden thinks she has reached crisis point and is having a complete breakdown.

She wants DM to be sectioned under the MH act and was calling me to let me know of her plans to contact the MH team and SS to try and get it done.

I don't have any direct experience but I don't think it's as easy as she might think.

How difficult is it to have somebody detained under the MH act? Do you think it'll happen?

Just to add- getting her in the MH unit was very difficult. The supposed crisis team would seemingly do anything to keep her out of hospital as that was the remit of their team. Even when she was threatening suicide constantly. It took her saying directly to the Crisis team that she would definitely kill herself if left alone, for them to finally act. If you/the warden can get your Adult Mental Health team involved that would be a start.

If your mum is sectioned due to mental health then there would be no need for a capacity assessment for this.

however, you can have her capacity assessed for understanding her alcoholism, accessing treatment, where she lives, etc. the social worker and any health care professional can help with this. They can also refer to the community learning disability team, however, she needs to have a confirmed diagnosis (on the LD register) and unable to access mainstream services for this

I am not they would section her in a facilities unless it was an alcohol rehabilitation unit or home program that would suit her with community support.

Unfortunately there is a lot of people within the community who live this way, that's why I believe a inpatient section won't happen.

I'm sorry for the stress.

I'm sorry OP, it's a really difficult situation. My mum was the same, her actions when drunk caused a nuisance for other people in her sheltered accommodation flats and we were all worried about her, though resigned there was nothing we could do (we'd tried, for years)
She was hospitalised (general ward) a few times after falls, given diazepam on the ward to protect her from the dangerous effects of withdrawal, and given information about community detox - which she didn't want, so as soon as she was medically fit she was discharged and continued drinking.

If your mum is presumed to have capacity to drink (rare that someone wouldn't really, unless there was another obvious factor like dementia that impacts on capacity tests or a very significant learning disability but that would have been picked up by now) then there isn't anything you or the warden could do . As others have said, alcohol dependency is specifically excluded within mental health legislation. They could try encouraging her to move to a service that supports dependent drinkers but they are few and far between (and can't do anything without her consent) In theory they could initiate eviction proceedings but it is unlikely they would from what you've said.

I'm sorry to say that if she's got to the point of not eating and having falls then she sounds pretty far gone on the dependency route and she might not have long. Not eating is usually a sign of stomach issues caused by alcohol, and with alcohol causing muscle wastage already, the impact of malnutrition/muscle loss/frailty is high, and the deterioration rapid. When my mum got to that stage she lost weight rapidly and we discovered the falls werent just due to being drunk, but nerve damage and muscle wastage in her legs. She had also stopped paying any attention to her hygiene or her flat, despite usually being quite particular about her hair and make up.

My heart goes out to you, it really is an awful position to be in.

A I said I used to be a mental health nurse ,and somebody can't be sectioned for being an alcoholic alone as its deemed as a choice, the mental health act is quite complex but it is Has very clear guidelines

I understand she is unwilling to engage with services making it impossible.

That’s not good OP and it must be very difficult for you. I would make sure Sue points out to social services that your mum should be considered under whatever their safeguarding procedures are as someone who may not be able to protect herself from harm as you or I would, due to her vulnerabilities. A question mark over her capacity adds an extra dimension. They should at the very least be having a co-ordinated response to this and formal discussion in my view. Everything needs to be explored properly including whether any sort of ‘guardianship’ type arrangements could be explored, if indeed she is found to lack capacity. I hope something is worked out for her.

I'm so sorry you've been through the same. Reading your post was like reading previous posts of my own.

Making a nuisance of herself at her sheltered accommodation, the brief hospital admissions only for her to go straight back to drinking, letting her appearance go (apparently she looks awful as does her flat), the rapid weight loss.

My heart is breaking today despite having put up such a wall where she is concerned. I had to let go for mine and my DC's sake but I still care about her and want her to be safe.

I don't think there is any way back for her now 😔

I've just had another call from the warden. She has spoken to the GP who told her to ring an ambulance to have her checked over as her presentation isn't good, apparently she's very shaky aswell as being dishevelled and unkempt.

GP as good as said she won't be sectioned, so you were all right about that. I knew it would be a long shot.

I've told the warden to mention her learning disability to the paramedics when they come.

It's incredibly frustrating having never been given access to her medical record as I just don't know what if anything is recorded about her LD.

I'm told she went to a special needs school for a while but never told about any diagnosis. My GP's are long deceased so couldn't tell me anything.

When I was a child and had social workers one of the reports said "suspected learning disability" so perhaps there's nothing formally diagnosed.

God knows how somebody gets to almost 70 without anything being diagnosed. My son has autism and was diagnosed by 3.

I think she has well and truly fallen through the cracks.

I'm so sorry to read this, OP.

I had exactly the same with my brother.

I was told he could only be sectioned if he was observed pointing a loaded gun to his head... that kind of thing. He needed to be an obvious and immediate threat to his own life. Merely drinking yourself to death doesn't quite cut the mustard.

Against all the odds, our efforts with my brother finally paid off after more than a decade of increasingly desperate and increasingly creative attempts to pull him out of it. The key was not how much love we had for him or how resourceful we were, but him actually wanting to be helped. It all flowed from there.

I really hope the same happens with your DM. All the best

Op, a possible route, although not a quick result is a referral to adult services under safeguarding- self neglect. But it may take numerous referrals, multi disciplinary meetings, GP, social worker assessments, etc to get an agreed plan. Capacity is also key.
no quick option and not mental health.

if you are nc, keep yourself protected, stay out of involvement. She is an adult making choices, even if you don’t agree with them.

💐for you

I have a bit of experience of this. Sectioning is off the menu, as you know now. It's hard enough even when someone is psychotic and begging to be prevented from murdering someone. I think your best hope is that she'll be admitted to hospital as an inpatient if she, say, has a bad enough fall, particularly if there are other findings, e.g. a UTI or some cardiovascular findings etc. The sheltered accommodation warden will probably take the opportunity to say she can't come back, and provided you keep yourself well out of the picture it will then be up to the hospital to find somewhere suitable to move her on to. Staying out of it yourself is key, because the NHS (understandably) will ideally want to offload her on to you rather than finding a care home vacancy. She will probably dry out in hospital or a care home, which will bring medical challenges in itself. I'm really sorry, it all sounds very difficult, and you'll probably need to harden your heart to it all until some kind of onward plan is effected, which will be hard in itself.

Diagnosis isn't necessarily the ticket some people think. Plenty of people with mild LD live perfectly independent lives in the community without ever needing any care services.
Also OP the fact of an LD even if diagnosed does not in itself indicate lack of capacity. It is a time and decision specific assessment and she would need to be assessed when sober.

You're absolutely right, that's the process that the warden is trying to kick-start now.

She wants her to be taken into hospital at which point she's going to tell them that she can't return as she can't keep herself safe and it isn't the place for her as they can't offer the supervision she needs.

The only issue I see arrising is that her sister will likely come forward and say she can go and live with her, or DM will give her sisters details and address, which will do nothing for getting her the support she needs as the sister is an enabler and has severe MH problems of her own. If DM ends up there she'll be dead within months as her sister just encourages her.

I should still be down as NOK so if the hospital contact me I'll explain that.

'Sue' told her she'd spoken to me and DM is upset with her about that.

Last I heard, 10 minutes ago, she has left her flat to get alcohol and then returned. Sue is calling the ambulance but she can't stay for too long to wait for it to arrive so if DM goes out again there's nothing anyone can do until she inevitably falls over outside again and is picked up via different means.

Thank you all for the advice and information. Its a real horrid thing to have to try to navigate. I said I would never get wrapped up in any of it again but it's hard to put that into practice and say "not my problem" when Sue is on the end of the phone beside herself after tying herself in knots to get her help.

I wouldn't get overly anxious about the learning disability diagnosis/history, as would be unusual for someone who was capable of living in the community to be deemed not to have capacity to drink alcohol - capacity is decision specific, and a decision to have an alcoholic drink is fairly low in complexity (compared to say, capacity to manage financial affairs)
I'm sure you already know this OP but adults with disabilities are in principle entitled to make their own decisions including 'unwise' decisions. The capacity test to overrule that is high, eg a cognitive impairment significant enough that they cant weigh up a decision, or to not be able to remember a decision (the memory to recall a decision is more clear cut and why dementia is more commonly a factor in capacity)

I know there are posters on here meaning well by talking about adult social care referrals, safeguarding etc, but one of the things I found most difficult when dealing with it all re my mum, was that I couldn't talk about it in public because everyone had well intentioned advice that there must be SOMETHING we could do, and that if we weren't doing anything it felt like we were failing her. I remember one vile person even said to my sister 'how could you let her drink herself to death'.

All we could do was pick up the pieces. We couldn't intervene, she had the right to keep drinking, the right to choose where she lived, the right to refuse to acknowledge drinking was a problem, the right to throw away the leaflets she was given, the right to bury her head in the sand. Even when she started to show cognitive effects from sustained drinking she was deemed to have capacity and was entitled to carry on.

I'm not criticising the capacity threshold btw, it has been hard won by people with disabilities to have autonomy over their lives and not to be infantlised. But it is bloody hard work for anyone close to them in situations like this..

Please protect yourself. Also you may already be aware, but social services will push on you if they have your details. Don't take it personally - the law says they have to try and put support from family in place before they're allowed to use public funding, even for simple things like transport home as part of a hospital discharge plan. Just be clear about your lack of contact and that you're not able to help.

Sorry cross posted, but - when feeling bad about the warden, just try and keep in mind that you're not capable of doing anything to fix the issue. The warden is coming to you because you're related, but your mum is an adult and you can't change her or the situation. Im sure if you could have you would have done so long before now.

Thank you I really appreciate it.

It's so, so hard isn't it? I feel as though people think of me the way that ignorant moron thought about your sister. What they don't realise is that there's literally nothing that can be done.

I used to keep her bank card with her permission and would manage her finances as far as sorting bills and food shopping. I would give her small amounts here and there when she wanted it and that worked to a degree to limit the drinking and antisocial behaviour. As soon as she wanted her card back I had to give it to her otherwise its me then breaking the law. I couldn't do that anymore 1) I don't want the responsibility as I just don't have the emotional bandwidth for it anymore and 2) she'll now be so physically dependent on alcohol that limiting her access to money could well put her life at risk.

I'll make it clear I'm not able or willing to house her or provide any support having exhausted all avenues many times.

Do you mind me asking if your mum passed away? I'm so sorry if that's the case. It feels inevitable in case of my mum. I have already done so much grieving for the relationship we could have had, I don't expect her death will come as any sort of surprise.

I'm in a similar position with exDH. He gets taken to A and E, is admitted for a week, detoxed, rehydrated etc. Once he can stand up with a frame they say he doesn't even need a Social Services assessment and send him home with no care package. And repeat....

This is very interesting

alcoholchange.org.uk/blog/2021/dying-with-their-rights-on

Someone on a thread on the Alcohol Support very wisely said you can't steal someone's rock bottom. For your own sake, you need to detach.

What did Two Blondes write?

Really hard! I've had clients having full on mental health breakdowns and had to call our local mental health services to say 'this person wants/needs to be sectioned' as they were crying our for help refusing to leave until someone helped them. There is no help. Not one was sectioned just offered a call back at some point.

The advice I have given is based upon the fact that this is explicitly my area of work and has been for many years, and what I would expect to see from social work response in my own area. There may be nothing can be done ultimately but services have a duty of care to make sure they are approaching this with careful consideration and that they are not making assumptions about what is or isn’t understood, or what is or isn’t a fully informed choice. OP does not have control over service response though obviously and even more difficult because of the situation.

I'm happy to answer any questions at all, it isn't something that is upsetting for me now (appreciate that might sound harsh but it's the reality)

My mum did pass away, it was over a decade ago so I've had time to come to terms with it. In her situation my sibling was living locally, I was 90mins away so not too far but not able to just pop by. My mum had had a few falls and had been struggling to get out. I had been organising some food deliveries and sibling had been popping in. This included buying their alcohol as we knew withdrawals could kill her, and also meant we had an idea what she was getting through.

Sibling couldn't get hold of her one day and used a spare key, found her passed out and couldn't rouse her. Paramedics took her to hospital. She wasn't diabetic but her blood sugars were dangerously low which was a complication of the drinking. Once she came round we found out that she couldn't walk at all, which was due to nerve damage (and would have been part of the reason for her falls) She did improve with the medical treatment she was having and was expected to be discharged but it was then found she had issues with her heart (alcohol related and smoking) and then developed pneumonia, which she didn't pull through from. She was very frail when taken to hospital, she was always petite but the alcohol abuse left her at 6 stone. So I think anything would have got her at that point. Honestly the way I processed her death was to see it as a slow suicide as the alcohol got her to a point that I don't think she wanted to live anymore.

It was hard at the time, and I felt very sad for her as she'd had a tough life and she was taken by the thing that she always enjoyed - she used to work in pubs, loved going out for drinks, I don't think she ever knew the risks about drinking, especially when she started to rely on it (she was the type to drink after a stressful day and as she got more anxious the more she drank) However I know it sounds awful and I don't mean to be insensitive - after she died and I'd got over the initial shock I felt relief. I'd felt emotionally responsible for her my whole life, as an adult I often felt like her parent, I dont remember ever feeling supported by her even as a child. So when she was gone I didn't have much in the way of good times to miss, and the absence of responsibility did feel like a weight was lifted. I just wanted to mention that so that if you're in the same position at some point you're prepared for it, as I felt really guilty about it especially when people were expressing sympathy (eg first Christmas, first mother's Day etc without her)

The last time we rang the police and they cancelled the call after the person waited for 2 hours then rang us and asked how the person was, like we would magically know after they left the building.

The social work response here has been very poor although DM doesn't help matters by refusing to engage.

The warden has been trying to get social services involved for atleast the past 18 months but it never goes anywhere. I don't actually know what my DM is saying to them if/when they get in touch with her other than the fact she won't engage.

@SilverPeacock apologies if you felt my post was a dig at you. I have some experience as a professional re capacity assessments, and used to work in 'wet' houses, though I certainly wouldn't say I have great current knowledge. However my comments were more because I thought I recognized the poster from previous, and if so I didnt think capacity and adult safeguarding was likely to lead to any outcome. That's not to say it's not worth enquiring, but I know from experience how disheartening it can be to battle for services when it makes no difference to the situation.

The discharge team social worker who assessed my mum told us that since she had to use a walking frame she would need us to do her shopping, therefore the drinking wouldn't be an issue as we would be in control of what we bought her. Honestly I wanted to punch her in the face. Zero understanding of the power of addiction or the lengths people will go to when addicted. I know that the job of adult SW is primarily gatekeeping and her conclusion was a way of assessing that no further paid support was needed. I work in a similar field and it is the reason I decided against working in that area.