NB, 3rd December 2020
The hearing I observed (COP 13677686) was before Mr Justice Peel on 18th November 2020. I chose to observe this hearing because I’d read the blog by Caroline Hanman describing an earlier hearing about “Michael” – a young man with autism, learning difficulties and ADHD. At that last hearing, the judge authorised continuing deprivation of his liberty in an unsuitable placement, pending this hearing, at which it was hoped that a suitable placement would have been found.
Sadly, at this hearing it was reported that no suitable placement had been found and the judge approved Michael’s move to another temporary placement which was already known to have risks for Michael, because there were no other options available. See Caroline Hanman’s follow-up blog for a description of what happened, and how an unsuitable placement was approved by the court.
I want to reflect on what I observed in the hearing of 18th November 2000 from my distinctive professional and personal perspective.
I have a career background of working in services for adults with learning disabilities, in particular those who are considered ‘difficult to reach’ because of their behaviour or isolation. Around 10 years ago I became a full-time carer for my son (about the same age as Michael) who has a complex mental health condition and we’ve experienced periods of full-time care services. Many of the problems faced by Michael and his family resonate with my own experience.
Up until August it seemed that Michael had been living in a property with a staff team and had been managing well. At some point in July the manager left and it was after that Michael’s behaviour started to deteriorate. This raised a big red flag for me, as surely it would be helpful for Michael if someone found out exactly why his behaviour had changed so dramatically. I imagine listening to his parents might provide some of the required details.
Michael is experiencing a lot of disruption. By the time I’d stopped huffing and shaking my head at the screen, I realised he would have been in five different settings within just one month: (1) his original property until 2nd November, (2) a hospital, (3) a place of safety, and then (4) the psychiatric unit where he is currently held. On the day of the hearing, he was being moved to (5) another interim placement. The plan is that this too is only temporary until he turns 18, so next year he will be moved again.
I wondered how on earth my child would have coped with this situation (he wouldn’t) and how stomach churningly awful this must be for his amazing parents. At some point a comment was made that ‘his parents visit openly and freely’. He’s not a prisoner – I felt the stigmatising language like a sting!
When counsel acting for Michael via the Official Solicitor (Mr Patel QC) sought a contingency plan if the interim placement broke down, the representative for the local authority (Mr Mahmood) said they would simply replace the care team! Without commissioner/social worker planning, oversight and staff training, it seems that the same mistakes could well happen over again. I wondered how Michael might respond to that sudden shift in a whole staff team. Could the risk level increase because of the lack of planning?
Apart from the direct staff team, I wondered, who is coordinating his care, understanding his needs (someone qualified in his diagnoses), training staff in his needs and ensuring that his needs are met? Where have CAMHS (the Child and Adolescent Mental Health Services) been? This young person should have been allocated a multi agency team to start planning his care. Where were they? Given that P has a diagnosis of autism, I wonder what support is available to him in the Autism Strategy, where he lives, as per the Autism Act 2009, and to what extent this has been explored. He surely also meets the criteria of Care and Treatment Reviews (CTR) as part of ‘Transforming Care’ as he’s obviously at risk of ending up in a hospital setting or Acute Treatment Unit. An independent panel of experts in a CTR, including experts by experience, may have created a turning point for Michael earlier on Unfortunately there hasn’t been a lot of ‘transforming care’.
I did wonder why the CCG doesn’t seem to have been involved with Michael’s care (or any forward planning for him). Considering Michael‘s multiple diagnoses and complexity of needs it would have meant that health services must have been involved at some point, to diagnose, so what happened? Was it a case of ‘signing him off’ and what I call ‘service ping-pong’ where no agency wants responsibility so keeps refusing access, all the while needs deteriorate?
At no point during this hearing was a transition phase from children’s to adults’ services discussed. Once Michael turns 18, CAMHS will no longer be involved nor will the children’s social services team. He will still be funded by the same LA, just a different pot of money. There was no mention at all of an EHCP (an Education Health and Care Plan can go up to the age of 25). What does Michael’s day consist of? Is he receiving an education? Has he received any input from psychologists or other therapists? Could such practitioners have helped with planning services and training staff to support his needs?
I have been my son’s care coordinator for many years. In our experience there is little or no communication between agencies. Even though I worked in health and social care services for years, I found that the system is like a maze and sourcing every provision has been a battle. Young people fall through the net. I hope adult services offer Michael the chance of stability and safety in his life and suggest that the next care coordinator ensures that his voice is heard and his family are involved.
NB wishes to remain anonymous to protect the identity of her son. She tweets @nb87120292