Andy developed mental ill health following a brain injury several years before. He had several admissions to hospital and unsuccessful placements in the community before being admitted to a residential care home. He was placed under a Deprivation of Liberty Safeguards (DoLS) authorisation and Advocacy Focus was allocated as his Relevant Person’s Representative (RPR) part way through a S21a Challenge.

Andy was struggling with the S21a process. He did not have a positive relationship with his then social worker, and now had to contend with a new RPR.

How did we help?

Our Advocate tried to engage with Andy to support him through the S21a process. Andy was in a highly anxious state and could not sit or stand still to have a conversation. He would pace around the building and garden perspiring heavily and running his hands through his hair. He was very defensive and would argue with anything our Advocate said, even when she was simply repeating back what he had said. He said that he didn’t want to challenge his DoLS anymore as he was sick of doctors and social workers who didn’t know him, asking him questions. He said he wanted to stay where he was in the care home. Our Advocate was concerned that he had changed his mind and visited him several times to make sure his decision was consistent. The court case was subsequently cancelled.

Our Advocate then gradually began to work on building a relationship with Andy. This was difficult due to his extreme anxiety. They would walk around the building and garden talking as he was unable to stay still. He was obsessed with talking about his past lifestyle before his injury, when he had a wife, children, a job, a house and a car. He was unable to look forward, as he was too angry and upset about everything that had happened. It was in many ways a grieving process for Andy. During this period, he was permitted to go out without staff support three times a week. However, he would drink excessively on these trips out, and would be verbally intimidating to staff and residents on his return.

As time went on, Andy and his Advocate developed a more trusting relationship. Our Advocate found that he was increasingly able to sit down and have a rational conversation with her and take on board what she said to him. He eventually began to believe that she really was on his side, and if she ‘challenged’ what he said to me, it was so that she could help him work towards achieving his goal of a more independent life. When the COVID pandemic hit, Andy was no longer permitted to go out unescorted, which he found very difficult. He began to talk about wanting to leave the care home again but was reluctant to go back to court. He agreed that our Advocate could ask a social worker to look at alternative accommodation options for him. However, the social worker said that this would not be possible until after the pandemic.

Andy accepted this initially as there were signs that restrictions would soon be lifted. However, when the care home went back into lockdown, Andy phoned his Advocate and said he needed to get out. He felt that being trapped in a care home 24 hours a day with residents with more complex needs than his own was becoming too much for him. He agreed that his Advocate could initiate another S21a Challenge on his behalf.

What was the outcome?

A new social worker was allocated for the S21a Challenge. Our Advocate was concerned about this initially as she knew that Andy did not respond well to new professionals. So she spent a lot of time talking to Andy and explaining why different parts of the process were necessary if he was going to achieve his dream of a new start and a more independent life. She explained that the court had asked the social worker to carry out mental capacity assessments regarding his ability to make decisions about his care and treatment. Andy was angry about this at first, but she explained that he would be able to leave the care home if he was able to understand and make his own decisions.

The new social worker turned out to be very positive for Andy and they worked closely from the start. Our Advocate had known Andy for two years by this time and was able to explain to his new social worker how Andy disliked feeling that he was being patronised or questioned for no good reason. By using a very skilled and sensitive approach, Andy accepted her involvement and was able to be honest and open with her.

She assessed Andy as having capacity to make decisions about his care and treatment and therefore his DoLS was lifted and the court challenge vacated. Our Advocate remained involved as his Care Act Advocate while the social worker searched for appropriate accommodation. This was a stressful time for Andy. Now that his DoLS was lifted, he wanted to experience more freedom, but the care home was still adhering to strict COVID restrictions.

Eventually, Andy was offered his own supported flat. Our Advocate had been working towards this with him for three years. All he was asking for was his own front door and peace and quiet. He wanted to be able to do the things that most people take for granted; shopping for his own food, and cooking the meals he chose.

Why was advocacy support was so effective?

It was very important for Andy to have a consistent presence in his life, as he had so many professionals and carers come and go. He often referred to people coming into his life and making decisions about him after ‘only knowing him for two minutes.’ He would often say ‘you know me now because you’ve been coming for a long time.’ He just wanted to be treated with respect and listened to.

Andy’s Advocate said:

“I would like to point out, how much Andy had changed in the three years I had known him and I encouraged him to take credit for that. He had previously felt quite ‘stuck’ and hopeless. He was 58 years old and felt that he would never have the freedom to live an ordinary life in the community again.

“I visited him at the care home on the day he was due to pick up the keys to his new flat. We were sitting side by side on a bench in the garden and Andy said, ‘I’ve come on a lot haven’t I?’ It was the first time he had taken any credit for the progress he had made.”