Welcome
A Multi-agency Conference dealing with the issues
of Financial Harm and Self-Harm
Themes:
Financial Harm: The opportunity to explore how adults are unfairly deprived of their assets, work together
to acknowledge this form of abuse, and take action to prevent harm.
Self-Harm: The opportunity to consider three forms of self-harm: self-neglect, self-injury and
self-poisoning.
Lynn Leitch
Team Leader
Housing and Neighbourhood Services
Self-Neglect
Introduction
• What is Self-Neglect in a Housing Context?
• Lifestyle Choice or Self-Neglect
• Housing Support
• Multi-Agency Involvement
Definition of Self-Neglect
“Failure by an individual to meet his or her own personal,
physical and health needs leading to a deterioration in
their condition affecting them and their environment”
“Unable to safeguard their own wellbeing, property,
rights or other interests”
Causes of Self-Neglect
• Motivation
• Health – Mental or Physical
• Substance Misuse
• Limited Life Skills
Lifestyle Choice
or
Self-Neglect
•
•
•
•
•
Independence
When should we intervene?
Endangering Neighbours
Anti-Social Behaviour
Public Health Issues
MARK
BACKGROUND
Aged 30 - a former Big Issue seller
Assault led to brain damage
Own tenancy
Substantial Income
REFERRAL
Complaints of Anti-Social Behaviour
Mark
ISSUES
•
Harassment of a vulnerable tenant
•
Damage to property
•
Nuisance to Neighbours
•
Capacity of tenant to say NO
SOLUTIONS
•
Housing Support
•
Social Work Guardianship
•
Supported Accommodation in new area
DOUG
Background
• 60 years old
• Alcohol Dependency
• One bed bungalow
Referral
• Referral from Social Work – Condition of
house
• Complaints from neighbours
Doug
Issues
• Alcoholic
• Poor Health
• Limited mobility
• Vulnerable
• Very poor state of house and furniture
Doug
Solutions
•Housing Support - Clean up, New Furniture
•Social Work Intervention
•Wet House - Plean Stirling
Update
•Asked to leave Wet House
•Presented as Homeless
•In temporary accommodation in Fife
Housing Support
•
•
•
•
•
•
Aim to help sustain tenancies
Often first agency to get involved
Work with the tenants to improve their situation
Refer to other agencies
Most effective solutions Multi-Agency
Can only work with tenant, not force changes
Conclusions
• Self Neglect / Lifestyle Choice
• Need to agree a criteria for intervention
• Not every case fits the criteria set down in
statute but may be as serious or worse than
those that do
• Balance the interests of the wider community as
well as the individual
• Multi-Agency Working is the way forward
Louise Bowman
Alcohol and Drug Partnership
Policy Officer
Self-Poisoning
Substance Misuse
intentional self poisoning?
A presentation by :
Louise Bowman
Fife Alcohol & Drug Partnership
Substance
noun
1. a particular kind of matter with uniform
properties
•an intoxicating, stimulating, or narcotic chemical
or drug, especially an illegal one:
(oxford dictionary)
“A drug, broadly speaking, is any substance that, when
absorbed into the body of a living organism, alters normal
bodily function “
(WHO - World Health Organisation 1969)
Substance misuse is defined as
intoxication by, or regular excessive
consumption of
and/or dependence on substances
that have an effect on the brain,
which leads to social, psychological,
physical or legal problems.
(NICE - National Institute for Health and Clinical Excellence)
The most commonly misused drug is alcohol.
Substance Misuse Prevalence in Fife
Alcohol
90% of Fife’s adult population drink alcohol
31.5% drink at hazardous / harmful levels
around 95,000
7.4% of are categorised as problem drinkers
around 22,000
Substance Misuse Prevalence in Fife
Drugs
• 1.38% (3300 individuals) of Fife’s population (15-64)
are estimated to be problem drug users in Fife
(opiates and benzodiazepines)
• No attempts have been made at a local level to
determine prevalence rates for other substance use
‘Hidden Population’
Of the 3300 estimated problem drug users
One third are in treatment
Of the 22,000 problem drinkers in Fife
One third are in treatment
Without knowing the prevalence of problem
use of other substances in Fife,
the ‘hidden population’ cannot be established.
Secrecy and shame accompany substance misuse
Service Use
Health Services
GP and Nurse Consultations, Psychiatric Team
Contacts, Prescribing & Pharmacy , Laboratory Tests,
All Hospital departments, Specialist Services
Hospital Admission Data 2005-2010 (majority A&E)
Around 400 drug related admissions per year in Fife
• Mainly male opiate drug users aged 25-34
Around 2200 alcohol related hospital admissions per year
in Fife
• Men over 40 account for half of all Fife discharges and
the number increases with age with the over sixties
being the highest
• Women aged between 40 – 49 have the highest number
of episodes for females in Fife in 2010
People from the most deprived areas in Fife have higher rates of
substance related hospital admissions – cause and effect
Social Care Services including Children
and Families and Criminal Justice
Prison Data 2011
• 50% of adult offenders serving a prison sentence in
2011 were drunk at the time of their offence
• 44% were under the influence of drugs
half of which committed their offence to buy drugs.
Most report difficulties with substances on the outside
impacting on employment and relationships
Housing, Police, Specialist Substance
Misuse Services, Education and
Community Services
Annual Societal Costs for Scotland sit at 3.2billion for drugs
and 3.5 billion for alcohol
Fife Drug Death Research 2005-2010
• 135 recorded drug deaths in Fife
Does not include suicides or fatal accidents
• Mean age 32 years old
• 50% had overdosed (non fatally) at least
once, the majority on multiple occasions
where recorded most were not intentional
• Average drug using career 17 years
The majority of victims had experienced a
combination of psychological and physical
difficulties as well as life events, rather than a single
problem alongside their substance misuse problems
Alcohol Client Profiles
Widow aged 65 (rich housewife with active social life)
withdrew from activities after husband passed away
“only a small sherry to help me through the day”.
GP referral through identification from an Alcohol Brief Intervention (ABI)
Male aged 24 (Engineer and Athlete)
“One off binge drinking session – didn’t ever drink more than one or two”
Criminal Justice referral for his single violent offence where victim sustained
serious head injuries
Female aged 44 (Support Worker)
(victim of teenage sexual assault)
“binge drinker consuming two bottles of wine before going out to the pub or
three bottles of wine when off shift mid week”
Her consumption caused her marriage to break down
Referred herself to treatment as alcohol was impacting on her ability to hold
down her job
Susan Matson
Clinical Nurse Specialist – Self-Harm
Self-Injury
Definition of self-harm
“Self-harm is (non-accidental)
self- poisoning or self- injury,
irrespective of the apparent
purpose of the act.”
NICE - National Clinical Practice
Guidelines Number 16, 2004
Common terms used to describe
self –harm.(NICE)
*Deliberate self - harm.
*Intentional self - harm.
*Para-suicide.
*Attempted suicide.
*Non-fatal suicidal behaviour.
*Self-inflicted violence.
How do people self –harm or inflict self-injury.
*Self-poisoning and self-injury.
*Self-injury also referred to as self-mutilation,
self-injurious behaviour, non-suicidal self-injury,
para-suicide.
*Self-injury is intentional harm to the outside of
the body often by cutting with a sharp object.
*Also self-injury by burning, hitting/punching,
picking, banging (head), scratching, jumping
from height, swallowing objects.
Less common types of self-injury.
*Objects inserted under the skin (needles)
*Insertion of foreign objects into orifices.
*Cutting of face is less common.
*Pulling out of one’s hair/eyelashes.
*Tie something fairly tightly around parts of the
body.
Presentation prior to self- injury.
*There can be very notable changes in a
person’s presentation prior to self-harming
where the person becomes withdrawn and
isolated.
*There can also be no outward signs prior to
self- injury.
Impact on Family
*Family members struggle to live with a
person who inflicts self-injury.
*However many relatives are totally
unaware of any self-harming.
What is unhelpful?
*Trying to force them to stop
self-harming.
*Things like hiding razor blades or
constantly watching, don’t work and only
lead to harming in secret, which can be
more dangerous.
Asking the person to promise not to self-harm
*Again this doesn’t work but puts on a lot of
emotional pressure and can set the person
up to fail and feel guilty.
Treating the person as ‘mad’ or ‘incapable’
*This takes away the person’s self-respect
and ignores their capabilities and strengths.
Functions served by self-injury.
It is better to have a few more scars
than be dead.
Panicking and over–reacting.
*This can be very frightening for the
person. It’s better to try and stay calm and
take time to discuss with them what
should be done next.
Telling the person off or punishing them in
some way.
*This can make the person feel even worse so
could lead to more self-injury.
Blaming the person for your shock and upset.
*You have the right to feel these things, but it
doesn’t help to make the person feel guilty
about it.
Jumping in with assumptions about why.
*Different people have different reasons for
self-harming. It’s best to let the person tell you
why they do it.
Just not talking about it.
*This won’t make it go away but will leave the
person feeling very alone.
Melanie Durowse
Training & Development Officer
Adult Support & Protection Team
Financial Harm
What is financial harm?
Financial harm is caused by the illegal or
improper use of the individual’s resources
(both financial and property) by another
person without their informed consent or
through the exercise of undue pressure.
Fife Multi-Agency Adult Protection Guidance 2011
Prevalence
•Financial harm is the 2nd most common form
of mistreatment for those living at home
(O’Keefe: 2007)
•57,000 people aged 66 and over had
experienced financial harm by a friend,
relative or carer worker (NatCen: 2007)
Prevalence
•Including neighbours and friends, the
number of people who have been financially
harmed rises to 86,500 (NatCen: 2007)
•60-80% of financial harm takes place in the
home and 15-20% takes place in residential
care (Crosby et al: 2007)
Prevalence
•50% of financial harm is by a grown-up son
or daughter and further 20% is by another
family member
•It is likely that financial harm is under
reported (NFA and ACPO:2009)
What do we know about
financial harm?
Diversity of the types of harm
•Not acting in the adult’s best interest
•Coercion and persuasion
•Misappropriation
•Theft/Rogue trading
•Mass marketing
Victims of financial harm
•Not in receipt of social care
•In receipt of social care
–Capacity
–Dependency
–Cognitive ability
–Communication
–Isolated
–Trusting
Impact on the adult
•Suffer as much as those of violent crime
(Deem: 2000)
•Anger, outrage, anxiety, stress, fear and
depression (Spalek: 2007)
•Distress and betrayal, loss of self esteem and
self confidence (SCIE: 2011)
Impact on the public purse
•Support for victims of fraud
•Funding for victims of fraud
•Professional reputations