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Home > Care and treatment for people with alcohol related brain damage in Scotland. A report on visits to people and services across Scotland in 2021.

Mental Welfare Commission for Scotland. (2021) Care and treatment for people with alcohol related brain damage in Scotland. A report on visits to people and services across Scotland in 2021. Edinburgh: Mental Welfare Commission for Scotland.

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Alcohol related brain damage (ARBD) refers to the effects of changes to the structure and function of the brain resulting from long term consumption of alcohol. There is no single cause of ARBD, which usually results from a combination of factors. These include the toxic effects of alcohol on brain cells, vitamin and nutritional deficiencies, head injury and disturbances to the blood supply to the brain. We chose to visit a number of people with a diagnosis of ARBD who are also subject to a welfare guardianship order. The intention of this themed programme of visits is to build on the Commission’s ARBD good practice guidance and its key learning points and to look specifically at the way that guardianship and its principles are used in this context.

Recommendation 1: Health and Social Care Partnerships should commission suitable, age appropriate and where possible specialist ARBD services.

As described in our good practice ARBD guidance and further evidenced in this programme of visits to people subject to guardianship orders, inappropriate community care home placements can precipitate dependency and isolation for individuals with ARBD. Despite the advent of self-directed support and our guidance we saw limited development of specialist, innovative approaches and services in Scotland to meet the needs of people with a diagnosis of ARBD. Where we did find this, more positive outcomes were clearly evidenced. Those commissioning services must consider whether they are breaching the person’s human rights if the person is compelled to live in a setting which they would never choose. 

Recommendation 2: Health and Social Care Partnerships should ensure allocation of the delegated officer role to a named individual to ensure consistency and continuity.

The Chief Social Work Officer delegates the role of guardian to a delegated officer; the Chief Social Work Officer remains accountable however. We found that the critical role of delegated officer was not always held by a named officer who maintained regular contact with the person subject to the restrictions of the guardianship order. We do not consider this to be in line with the spirit of the legislation. Where a decision has been taken by the local authority to intervene in a person’s life on a statutory basis, there should be a named delegated officer building a trusting relationship and ensuring that the order is meeting the person’s outcomes in line with the principles of the Adults with Incapacity (Scotland) Act 2000 (‘the AWI Act’). 

Recommendation 3: Community care review activity within Health and Social Care Partnerships should be dynamic, coordinated processes which include review of personal outcomes, care plans, placement, the guardianship order and whether all or some of the powers remain relevant.

Multidisciplinary reviews should be dynamic, coordinated processes informed by the principles of the AWI Act, maximising both the contribution of the person and their carers/relatives where appropriate. We found that reviews did not always focus on outcomes, the placement and the powers of the order. It is important to ensure that those involved are not passive recipients of information but have ongoing relationships that allow them to actively contribute to the review process. 

Recommendation 4: Health and Social Care Partnerships’ strategic advocacy plans should include focus on accessibility of advocacy support at all stages of the care and support continuum.

We have highlighted the challenges of supporting the rights of people with a diagnosis of ARBD to live as they choose balanced with their rights to access support to maximise their quality of life. The offer of advocacy support is an important safeguard to ensure respect for the rights, will and preferences of the person and not what is considered by others to be in that person’s best interests. Advocacy support is important prior to the guardianship application stage, post guardianship and throughout the provision of continuing care.

  • Where recommendations are made to health and social care partnerships, this refers to the joint operational arrangements that exist in a council area between local authority social work services and health care services of the local health board.

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