Wednesday 23 January 2008


A patient became unwell. She was admitted with F31.20 Bipolar affective disorder, current episode manic with mood-congruent psychotic symptoms.

Her manic episode had left a swathe of destruction behind her. Her house was trashed. Her and her neighbours' gardens were trashed. Her car was smashed up and is no longer road worthy. She'd spent slightly over £10000 on goods that were then not wanted and given away. She offended friends, carers, family (including her hypomanic daughter who's also an in-patient) and folk in her locale. When she regains insight and has to face the legacy of her manic phases she's invariably incredulous and ashamed in equal measure.

She ended up under my care by chance. I'd never met her before, she was under the care of general adult psychiatry but when she became manic they felt she was best managed on old age wards (she's in her 70's) than their wards so I took over her care.

One element that's emerged is she's financially exploited by her daughter who'd taken over £100000 from her accounts over the last 5 or 6 years. Her social worker thought this was okay since the daughter, "would get the money when she dies, anyway."

She's now had adult protection meetings (through PoVA) and her finances are, now, protected.

Her daughter will, indeed, gain her entire estate when she dies. But, 'til then, it's hers.

The pragmatic approach of social workers in the local area teams is presumably a helpful trait for them to function and get things done. I know that the evidence of what we'll see over the next few months for our patient won't be any different now her money's protected (she won't be any iller or healthier, she won't have more or less stress, her activities will be unchanged). I know that the long term outcome for my patient is poor (she's in biventricular heart failure that physicians can't control), she will die and her daughter will get everything.
Despite this, the pragmatic approach of letting her be exploited, even though it had no massive tangible impact, was anathema to me and the rest of the mental health team.

The more I experience of mental health and social care communities working together, the more I see social care doing what they believe is pragmatic and mental health services doing what they believe is right.


Dr Andrew Brown said...

A tricky one. I can see the SW's point of view but, as you say, it doesn't feel right.

xyz said...

The pragmatic approach unfortunately has the potential of facilitating collusion between the relative of the patient and the patients carer. Better to do what is right. If the daughter wants control of her mother's assets there is a proper process to go through (obtain a Lasting Power of Attorney). Going through this process also protects the social services from accusations of connivance.
Mr Leatherhead

The Shrink said...

Wholly agree.

Even though there may be no material difference, doing what's right makes things above board and beyonf reproach.

From personal experience I know that, too, it really does change the culture of a team, inculcating more lofty idealistic practice.

Much goodness.