Collaboration & the elephant in the room (substance misuse)

Supporting a Case Manager with a complex care plan and difficult decisions during a pandemic

CASE: A – Acquired Brain Injury & loss of support network due to partner leaving the family home.

During the Global Pandemic and National Lockdown, Browns Case Management was asked to lend its team’s experience to assist a fellow Case Manager at another company. The Case Manager and Deputy knew that Browns Case Management had the knowledge and expertise that would benefit them on a particular case. Michael (pseudonym) was a young adult with a complex Brain Injury and care needs. Michael was initially discharged into the community to continue with his rehabilitation; however, a formal review of his DoLS Authorisation was outstanding. This was compounded by the fact that he was being managed and moved between two Local Authorities and adapting to the loss of his partner who had recently left the family home with their child, due to the psychological impact Michael’s brain injury was having on their child. This had resulted in a Child Safeguarding Referral. It was quickly recognised that there had been no formal capacity assessments, completed by either the individual Local Authorities or clinicians, in respect of specific decision making and Michael was using Cannabis on a regular basis, which further impacted the complexity of the case and the fragility of the existing care package.

The initial assessment with Michael, his team and I confirmed that he displayed some aggressive behaviours when out in the community and that pre morbidly, Cannabis was a large part of his life. It was increasingly apparent that the care team had ‘turned a blind eye’ to Michaels’ Cannabis use and where this was coming from. It was clear that the care team and Michael’s

family were experiencing guilt over the losses Michael had experienced thus far (his job, social, and family life) and that the use of Cannabis was the ‘only thing he had left and had control over’. Cannabis was easily available to Michael via visiting family members, and this resulted in the care staff not feeling confident enough to challenge them regarding the legality of the activity or to consider that the use of pre rolled Cannabis joints could Browns Case Management be harmful. Further, ‘enabling’ facilitated discussions with the Michael to continue to access team to identify the need to Cannabis appeared to be an effective method of managing review the ongoing use of the more undesirable aspects of Cannabis, that pre dated the Case his negative behaviours. Due to the large number of

Manager’s involvement. essential professionals involved in Michaels rehabilitation, clarity in respect of agreed strategies and methods was lacking. Browns Case Management facilitated discussions with the team to identify the need to review the ongoing use of Cannabis, that pre dated the Case Manager’s involvement. It was agreed that the priority was to confirm Michaels capacity to make decisions regarding illicit drug use, namely Cannabis and confirm the outcome, with Michael, his care team and family members. The team agreed that it was extremely important that Michaels family were involved in the process and that they needed to be very clear in respect of the rationale for clinical decisions, that needed their support. Further, all parties, including staff members required urgent training and supervision to ensure that they understood the legality of Cannabis use in the UK and their role in ‘enabling’ a vulnerable adult to access illegal drugs. Upon completion of the Capacity Assessment with Michael, a number of strategies were agreed and an updated care plan was confirmed. This covered plans for family contact at Michaels home, rather than family homes, clear Person Centred Strategies and Protocols for care staff to follow and implement, as well as an audit of Michael’s spending and access to money, that then could not be used to reimburse others for Cannabis and

minimise the risk of financial exploitation by family and friends.

Michael agreed to the following, with the support of his case manager and rehabilitation team:

Contact with family would be within his own home. This would facilitate a more robust response to any aggressive or unsolicited behaviour from Michael when family would not provide him with Cannabis. Michael understood that they would leave and not return.

The support team would complete an audit of his spending and allowances, which would support a more safe and effective method of safeguarding Michael against the purchase of Cannabis and risk of financial exploitation by others.

The Rehabilitation Team were able to discuss and come to an agreement to make contact with the local police and remove all paraphernalia associated with Cannabis from Michaels home, with his permission.

Due to an unrelated and pre planned hospital admission, Michael to abstain from Cannabis for ten days. The Rehabilitation Team were able to discuss and come to an agreement to make contact with the local police and remove all paraphernalia associated with Cannabis from Michaels home, with his permission. This enabled him to return home following a period of abstinence and managed triggers.

Although very difficult, the nationally imposed restrictions in response to the Global Pandemic impacted contact arrangements and visits with people outside of Michaels ‘bubble’, which supported the agreed strategy that family would not be asked to supply Cannabis. This was maintained throughout the ongoing lockdown.

The support from Browns Case Management continued beyond this initially complex and challenging situation and has evidenced how a collaborative approach between agencies can ultimately support clients with very complex needs and social issues, to remain safe within their preferred local community.

Michael is now settled, has regular supervised contact with his son, an established support team, that continues to support his abstinence from Cannabis and meaningful and supportive contact with his family. Browns Case Management remains in close contact with the Case Manager, Deputy and the Rehabilitation Team to offer support, guidance and intervention as required to maintain this successful regime. ■

This is another example of Browns Case Managements client centred approach, to find out more about how we can help please contact us at: info@brownscm.com Web: www.brownscasemanagement.com