Laura Winham

[worriediambecomingrightwing]

This is an absolutely horrible, tragic story from the BBC website today. This poor lady with schizophrenia was totally neglected and failed by every service who had responsibility towards her and lay undiscovered for three years after she died. It’s really heartwrenching:

www.bbc.co.uk/news/uk-england-surrey-64400776

However, aibu to think that this framing by the family is a bit… off? It can obviously be very hard to maintain relationships with a severely mentally unwell family member, especially if you become a negative figure in their delusions, but surely you would still attempt to maintain contact and advocate for them? How can they not have heard from her for three years and not checked up on her? I believe that social services and mental health services have a responsibility to do better, I would never defend them in this case… but don’t families have a responsibility too?!? AIBU???

Should say that I’m really happy to be ripped a new one and shown the error of my ways. Am worried this sort of reaction is a sign I am slowly becoming right wing! Obviously the big systemic problem here is the negligent underfunding of services by the Tory government, and others before them! But I just found the “family denounces services” framing of the story on the BBC website really, really infuriating.

It mentions that she refused to see her family because she thought they would harm her. So there is probably little they could do. GPs and other health services, and possibly social services too, won't speak to a family member about a person's care unless given permission (which she presumably didn't give). From experience with elderly relatives I know how impossible it is to get help for someone who doesn't want it.

I do agree that if I was her relative, I would still check she was OK from time to time. But maybe that caused her so much distress? Who knows, but I suspect it was a v complicated situation, and not as simple as described in the short article.

If she wasn’t willing to open the door or answer the phone to her family, then I imagine she simply behaved the same way towards any services who tried to engage with her. Whilst tragic I’m not sure what the Tories have to do with this: it’s a very sad case of somebody with severe mental health problems not engaging and services having limited powers to force somebody to accept help.

Obviously we don’t know the full story, but it is very difficult for services to become involved if the person if the person isn’t willing to engage- it’s such a complex topic. Services are unable to “give their side of the story”, so to speak, so that isn’t alway apparent.
This poor woman- I saw this earlier and it’s a tragic story. That last entry in her calendar was chilling.

I did sort of think similar OP when I saw how much the family were blaming the agencies.

This is heartbreaking. Some patients are almost too mentally ill for services to actually access them and it often ends in tragedy. Mental health is by far the most complex and difficult health issue to manage- especially as ifs so varied. And our services in the UK are so poor. But yes- if I was in her family I’d be keeping more contact and I certainly don’t think it’s fair to completely blame SS etc.

@Columbina I’m sure you’re right, it’s a very short article that no doubt leaves a lot out! But patient confidentiality only works one way - there’s nothing stopping family regularly bothering social services, even if it’s just to say “X still won’t talk to me”. I struggle to imagine how you wouldn’t check up for three years!!

@ComtesseDeSpair the mental health act is there precisely because many people suffering serious MH problems don’t have capacity. It’s not nice to section someone or put them under a community treatment order, but this sort of situation is exactly what that is designed to prevent. And you’re right it’s not only the tories who neglect MH, but they’ve presided over 12 years of austerity in which things have only become worse.

Also, why do the police say they found her but the article also says her brother found her?

From your OP, YANBU. But from the actual detail of the case YABU. They weren’t contacting her for her own benefit and under the advice of professionals. The family didn’t engage with her, despite how hard it was for them because they were led to believe it was best for her by professionals who then failed to do their jobs to safeguard her.

I worked for housing associations pre-Tories as well as after. We had several tenants with severe mental health problems who lived in terrible states: I won’t be surprised if I ever read about one of them in a similar story to this one. Our housing and support staff went to enormous lengths to liaise and coordinate with care and social services to help them but it’s very difficult when somebody doesn’t want to accept help and is actively disengaging with services - particularly if they’re becoming increasingly distressed by the interventions themselves. The police don’t like to get into the habit of breaking somebody’s door down to gain access unless they have reason to believe the person is at immediate risk of harm (and overall, this is a good thing) so once somebody has withdrawn, it’s complex. Obviously better funded services provide a better service, but it isn’t quite as simple as just detaining people because you believe they don’t have capacity.

The brother found her, he made a report, the police responded to the report and they found her body. It was, essentially “found” twice. Something doesn’t need to be “lost” to be found.

@DownInTheDumpster there is a huge grey area I find in terms of patient willingness and ability to access MH services. From the sound of this this poor lady should have been a candidate for section because she was a danger to herself and had such limited capacity. But lots of other patients as you say are too ill to access services really, but MH services tend to have a very unforgiving “if you don’t want our help (on our terms) then there’s nothing we can do for you”. I think it’s driven by massive underfunding really, and also there are certain MH conditions that benefit from that sort of robust boundarying. But mostly it’s just sad and not good enough for a whole lot of really vulnerable people who struggle to engage with MH in their current quite punitive form, but would almost certainly engage if there was more kindness and flexibility!

The MHA is a two way street- it’s is also designed so people’s autonomy is upheld in all but the most extreme circumstances. You have to be able to prove beyond doubt that the individual can’t make these decisions.
How do you escalate if somebody is unwilling to speak to you? Kick their door in? Arrest them? Unless that person appears in immediate danger you can’t do that. Certainly not off the back of two vague reports of a dishevelled, hungry looking person.

Does sound like the family have retrospective guilt and regret.

@ComtesseDeSpair I know that, I also have a background in this area. Hence why I say it is not nice to section someone and should not be used lightly. But it is done sometimes if there is a serious risk to self or others, and that can include severe self-neglect. And as I was saying to a pp, there is a continuum of MH problems, and lots of people who neglect themselves and struggle to engage sort of do have “capacity” (a very simple word for a very complex problem), but incredibly unwell psychotics usually… less so.

@BriceNobeslovesMurielHeslop obviously we don’t have enough details of this case to make our own clinical judgements. But if someone has a diagnosis of schizophrenia and is known to MH services to suffer from upsetting paranoid delusions that are causing them to disengage from services and treatment then you shouldn’t really discharge them for non-engagement! At the very least there should be a key worker trying to keep a eye, even if the threshold for section is very very high.

Whilst I agree with many of the sentiments here, have you any idea what a case workers workload is like? It is simply impossible to allocate "cases" to staff - they are already overwhelmed by those who can or must engage, without also trying to maintain working with people who won't. In a perfect world there'd be enough staff for all eventualities. In this world there aren't enough for the existing demand.

One can argue forever about what the threshold for mental capacity ought to be. I am old enough to recall the people who were sectioned for being single mothers, or even for epilepsy and extreme allergies! In my student days I worked in home for people who had previously been in mental institutions, and you would be incredulous if you'd seen their case notes. One man spent 40 years in an institution because he had violent fits - he had an allergy to dairy products, but back in those days they didn't know about such things.

If someone is medically deemed to have capacity, then they have the same right that you or I do to tell services that they won't engage. And it's a dangerous line being crossed when we decide to remove that right from some people. I don't know where that line is. Neither does anybody else. And if her own family, even with good cause, couldn't maintain even minimal contact with her, I'm not sure how anyone can expect services to do what they can't.

That wasn't the case. The one referral by the Police and the referrals by the family, weren't picked up. If there was no contact, then there should have been follow up visits and the MH act used because we don't, or rather shouldn't leave people to die.
We know that she was failed, she's dead, found after three years.
As said if someone has capacity then they can have you charged with harrasment if you continue to try to make contact. At the very worse, you can find yourself physically threatened (personal experience). In my case luckily the police turned up because my relative had their hand around my throat, strangling me. On numerous occasions I was threatened in my own home, so we're my children. You have absolutely no idea what it is like to have to hand care over to services.

"And if her own family, even with good cause, couldn't maintain even minimal contact with her, I'm not sure how anyone can expect services to do what they can't."

There wasn't an attempt to, even though the police were concerned.
Thankfully the enquiry will stick to the facts.

Family/social services aside, why didn't neighbours notice anything?

In a similar case quite recently a woman was left and neighbours in the flats noticed a smell, piled up post etc and told the authorities - yet nothing was done. At least the neighbours in that case knew something was amiss.

Sad how this can happen. Disappointed in society as a whole.

I think it’s unfair to blame the neighbours. I’ve lived in blocks of flats where I don’t think I saw a couple of the neighbours who lived on my landing more than two or three times in several years. It’s not like houses, where you see your neighbours in the garden, or taking their bins out on bin day. And social housing block communal areas can be stinky: not always particularly well cleaned, rubbish dumpster store not always emptied often enough, people with large dogs in small flats. I can easily see why neighbours wouldn’t think anything of not having seen her in a while or think a bad smell all that unusual.

Yes it will. Quite rightly. Instead of assumptions based on one side of the story. The article does not say that there was no attempt to follow up. It says that there was no follow up. That would also be the wording if she refused to engage. There may or may not have been failures on the part of services. It is inappropriate to assume that based on a one sided story from the point of view of her relatives. As inappropriate as assuming their version is entirely accurate.

Perhaps the services did miss opportunities. Perhaps they didn't. Nobody knows. But that doesn't change the fact that resources are now so scarce that there is no capacity to chase clients. It's easy to criticise, whilst simultaneously bemoaning how many taxes one doesn't want to pay... The nation gets the services it pays for. Mental health services have been in crisis, both for adults and children, for many years. It isn't any sort of surprise. But it's easier to blame the people in services for failing rather than face the reality that if we want better services they must be paid for. Or that if we don't want to pay for them, we must cut our cloth accordingly and accept lower levels of service to the most vulnerable.

I'm not at all suggesting the latter. But I am fed up of the moral outrage of people about their expectations of services they are neither willing to pay for nor to support, from schools, social services, and the NHS through to the police and fire fighters etc. It is small wonder the public sector cannot recruit.

@Quveas yes, I work in the public sector in an adjacent field and I have a very good idea what a case worker’s workload is like. As I’ve stated from the beginning, this is a matter of under-resourced services not able to deliver the care that they would in an ideal world. I’m not personally blaming SWs or MH practitioners. It’s unwinnable at the moment. Hence what got up my nose in the BBC article in the first place was the family who hadn’t checked on her in three years blaming services!

The smell of a decaying body is a smell like no other.

How the neighbours didn't report the smell is unbelievable.

Very sad case but unfortunately it won't be last time this happens.

I feel the same, OP, and I do think the family bear some responsibility. Three years of no contact before her brother goes to her house and takes a look through the letterbox - knowing that she suffers from serious and intractable mental health issues, it beggars belief that they didn't raise the alarm before. I know they were estranged but she was hugely vulnerable and they would have known that.