Paternalism or proportionality? Experiences and outcomes of the Adult Support and Protection (Scotland) Act 2007

2014 ◽  
Vol 16 (1) ◽  
pp. 5-16 ◽  
Author(s):  
Michael Preston-Shoot ◽  
Sally Cornish
Keyword(s):  
At Risk ◽  
Service Delivery ◽  
Family Members ◽  
Service Users ◽  
Content Type ◽  
Protection Orders ◽  
Scottish Government ◽  
Principle Of Proportionality ◽  
Adult Protection ◽  
Adult Support

Purpose – The purpose of this paper is to report the findings from research into the outcomes of adult protection in Scotland, with particular focus on how service users, family members and service delivery professionals perceive the effectiveness of the protection orders in the Adult Support and Protection (Scotland) Act 2007. Design/methodology/approach – The study comprised analysis of Adult Protection Committee biennial reports on implementation of the 2007 Act to the Scottish Government, key informant interviews and workshops with professionals involved in adult protection leadership and practice, and case study interviews with service users, family members and practitioners. Findings – Concerns about the potential for paternalistic practice and excessive use of the protection orders within the 2007 Act have not materialised. The principle of proportionality appears to be firmly embedded in adult protection practice. Service delivery professionals, service users and family members remain acutely aware of the tensions between autonomy and protection but point to beneficial outcomes for adults at risk from the careful use of protection orders, especially banning orders. Research limitations/implications – Only ten case studies were able to be included in the study. However, the use of mixed methods enabled triangulation of the findings. Common themes emerge from across the data sources. The findings also resonate with conclusions drawn by other researchers. Practical implications – The paper identifies outcomes and challenges in respect of protecting adults at risk in Scotland. Strengths and limitations of the 2007 Act are identified. Originality/value – The paper offers a formal evaluation of the outcome of protection orders for adults at risk in Scotland. The findings are of wider policy relevance given the debates on how to legislate for adult safeguarding in England and Wales.

Human rights of people with mental illness diagnosis: perceptions among service users, family members and health professionals in Tunisia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mayssa Rekhis ◽  
Sami Ouanes ◽  
Abir Ben Hamouda ◽  
Rym Rafrafi
Keyword(s):  
Mental Illness ◽  
Human Rights ◽  
Family Members ◽  
Mental Illnesses ◽  
Service Users ◽  
Content Type ◽  
People With Mental Illness ◽  
The Family ◽  
The Right ◽  
Main Factor

Purpose This study aims to assess the awareness about the rights of people with mental illness in the main psychiatric hospital in Tunisia among the service users, the family members and the staff. Design/methodology/approach The Convention of Rights of People with Disabilities mandates that State Parties initiate and maintain campaigns and human rights training to promote understanding of the rights of people with mental illnesses, considered as a main factor for their fulfillment. Service users, family members and staff evaluated, through a survey, the importance of ten rights for persons with mental illness, stated in the convention. Findings Disparities were found in the perception of the different rights by and between the three groups. The highest levels of awareness were associated with the freedom from torture or degrading treatment and the right to live with dignity and respect, whereas the lower importance were assigned to the right to participation in recovery plans, to give consent and to exercise legal capacity. Originality/value The lack of awareness and the poor perception of rights of people with mental illness is one of the barriers to their achievement. More training and awareness raising is necessary.

scholarly journals Adult Support and Protection (Scotland) Act 2007: reflections on developing practice and present day challenges

2017 ◽  
Vol 19 (4) ◽  
pp. 187-198 ◽  
Author(s):  
Kathryn Mackay ◽  
Mary Notman
Keyword(s):  
Good Practice ◽  
Annual Reports ◽  
Content Type ◽  
Study Approach ◽  
Protection Orders ◽  
Legislative Framework ◽  
Potential Risks ◽  
Local Agencies ◽  
Adult Support

Purpose The purpose of this paper is to outline the duties and powers of the Adult Support and Protection (Scotland) Act (ASPSA) 2007 and place them in the wider Scottish adult protection legislative framework. It considers the potential value of a standalone adult safeguarding statute. Design/methodology/approach The authors draw upon their research and practice expertise to consider the merits of the ASPSA 2007. They take a case study approach to explore its implementation in one particular Scottish local authority, drawing on the qualitative and quantitative data contained in its annual reports. Findings Skilled, knowledgeable and well-supported practitioners are key to effective screening, investigations and intervention. Protection orders are being used as intended for a very small number of cases. Research limitations/implications The lack of national statistical reports means that there is limited scope for comparison between the local and national data. Practical implications Adult support and protection requires ongoing investment of time and leadership in councils and other local agencies to instigate and maintain good practice. Aspects that require further attention are self-neglect; capacity and consent and residents in care homes who pose potential risks to other residents and staff. Social implications ASPSA 2007 has helped to raise awareness of adults at risk of harm within the local communities and as social issue more generally. Originality/value The authors provide a critical appraisal of the implementation of Scottish adult safeguarding legislation over the last six years. They consider similar developments in England and Wales and argue for comparative research to test these out. Finally, they signpost future directions for bridging separate policy streams.

Adult protection training for community nurses: evaluating knowledge following delivery using participant-favoured training methods

2014 ◽  
Vol 16 (1) ◽  
pp. 17-28 ◽  
Author(s):  
Martin Campbell
Keyword(s):  
Repeated Measures ◽  
Control Group ◽  
Training Methods ◽  
Content Type ◽  
Repeated Measures Design ◽  
Training Activities ◽  
The Impact ◽  
And Training ◽  
Adult Protection ◽  
Adult Support

Purpose – The purpose of this paper is to measure nurses’ knowledge about Adult Support and Protection (Scotland) Act 2007 before and after a one-day training course using participants’ favoured methods of training activities. Design/methodology/approach – A repeated measures design was used to evaluate the impact of a one-day Adult Support and Protection training on pre-training knowledge of community nurses across one NHS area. Participants’ favoured methods of training activities were used in the training. Participants were community nurses working in learning disability, mental health, older people's services, acute services, substance misuse, and accident and emergency. All completed a training needs analysis and training preferences study. Individual and group scores on an Adult Support and Protection knowledge questionnaire were analysed pre- and post-training. Findings – There was a statistically significant increase in scores post-training (Wilcoxon's signed-ranks test). Individual increases ranged from 2.5 to 27.5 per cent, with a mean score of 15 per cent. Evaluation of the impact of nationally approved Adult Support and Protection training is needed and training should take account of participants’ existing knowledge and preferred methods of training delivery to improve the transfer of learning into practice. Research limitations/implications – Participants were self-selecting. Existing knowledge was not controlled for in the sample. No longitudinal follow up to measure retention of any improvements in knowledge. No control group. Training methods used were based on the expressed preferences of 40 nursing staff, but only 18 of these staff participated in the training day. Originality/value – There is a dearth of research in evaluating the impact of the adult protection training on staff knowledge and understanding. Designing training activities and content to take account of participant preferences, and areas where knowledge is weakest may enhance the effectiveness of training in this area. This research was funded as a Queens Nursing Institute Community Project. It builds on a pilot project

scholarly journals Therapeutic institutions of violence: conceptualising the biographical narratives of mental health service users/survivors accessing long term “treatment” in England

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stephen J. Macdonald
Keyword(s):  
Mental Health ◽  
Family Members ◽  
Psychiatric Hospitals ◽  
Term Treatment ◽  
Service Users ◽  
Content Type ◽  
Criminal Violence ◽  
Long Term Treatment ◽  
Forms Of Violence

Purpose This paper aims to conceptualise the residential and psychiatric hospital as a space where criminality and social harms can emerge. Because of recent media scandals over the past 10 years concerning privately-owned hospitals, this study examines the lived experiences of service users/survivors, family members and practitioners to examine historic and contemporary encounters of distress and violence in hospital settings. Design/methodology/approach The study consists of 16 biographical accounts exploring issues of dehumanising and harmful practices, such as practices of restraint and rituals of coercive violence. A biographical methodology has been used to analyse the life stories of service users/survivors (n = 9), family members (n = 3) and professional health-care employees (n = 4). Service users/survivors in this study have experienced over 40 years of short-term and long-term periods of hospitalisation. Findings The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. Practitioners recalled comprehensive experiences of violence within historic mental hospitals, although violence that may be considered criminal appeared to disappear from hospitals after the Mental Health Act (1983). These reports of criminal violence and coercive abuse appeared to be replaced with dehumanising and harmful procedures, such as practices of restraint. Originality/value The data findings offer a unique interpretation, both historical and contemporary, of dehumanising psychiatric rituals experienced by service users/survivors, which are relevant to criminology and MAD studies. The study concludes by challenging oppressive psychiatric “harms” to promote social justice for service users/survivors currently being “treated” within the contemporary psychiatric system. The study intends to conceptualise residential and psychiatric hospitals as a space where criminality and social harms can emerge. The three aims of the study examined risk factors concerning criminality and social harms, oppressive and harmful practices within hospitals and evidence that violence occurs within these institutionalised settings. The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. These reports of violence include dehumanising attitudes, practices of restraint and coercive abuse.

scholarly journals Inter-agency adult support and protection practice

2019 ◽  
Vol 27 (1) ◽  
pp. 50-63 ◽  
Author(s):  
Sundari Joseph ◽  
Susan Klein ◽  
Samantha McCluskey ◽  
Penny Woolnough ◽  
Lesley Diack
Keyword(s):  
At Risk ◽  
Social Services ◽  
Information Exchange ◽  
Social Care ◽  
Realistic Evaluation ◽  
Content Type ◽  
Health And Social Services ◽  
Evaluation Approach ◽  
Health And Social Care ◽  
Adult Support

Purpose Collaborative inter-agency working is of paramount importance for the public protection agenda worldwide. The purpose of this paper is to disseminate the findings from a research study on the inter-agency working within adult support and protection (ASP) roles in the police, health and social care. Design/methodology/approach This realistic evaluation study with two inter-related phases was funded by the Scottish Institute for Policing Research. This paper reports on Phase 1 which identified existing gaps in the implementation of effective inter-agency practice by reviewing the “state of play” in inter-agency collaboration between the police and health and social care professionals. In total, 13 focus groups comprising representatives from Police Scotland (n=52), Social Care (n=31) and Health (n=18), engaged in single profession and mixed profession groups addressing issues including referral and information exchange. Findings On analysing context-mechanism-outcome (CMO), gaps in joint working were identified and attributed to the professionals’ own understanding of inter-agency working and the expectations of partner agencies. It recommended the need for further research and inter-agency training on public protection. Research limitations/implications This unique Scottish study successfully identified the inter-agency practices of health, social services and police. By means of a modified realistic evaluation approach, it provides an in-depth understanding of the challenges that professionals face on a day-to-day basis when safeguarding adults and informed strategic recommendations to overcome the barriers to good practices in organisational working. The methods used to determine CMO could benefit other researchers to develop studies exploring the complexities of multi-causal effects of cross-boundary working. The use of the same case study in each focus group helped to neutralise bias. However, the voluntary nature of participation could have resulted in biased perceptions. The limited numbers of health professionals may have resulted in less representation of health sector views. Practical implications This paper reports on a Scottish study that focused on the coordinated and integrated practices amongst the police, health and social services’ professionals who support and protect adult members of society at risk of harm and has implications for their practice. Social implications Whilst the focus of this study has been on ASP, the conclusions and recommendations are transferable to public protection issues in many other contexts. Originality/value Studies on the joint-working practices amongst police and health and social services’ professionals who support and protect adult members of society at risk of harm are uncommon. This study investigated professionals’ perceptions of gaps and concerns pertaining to integrated working by means of a realistic evaluation approach. It recommended the need for further research and inter-agency training on public protection.

scholarly journals Adult protection in Scotland in 1857 and in 2015: what have we learned?

2016 ◽  
Vol 18 (2) ◽  
pp. 96-108 ◽  
Author(s):  
Martin Campbell
Keyword(s):  
At Risk ◽  
Public Awareness ◽  
Ecological Factors ◽  
Evidence Base ◽  
Annual Reports ◽  
Policy And Practice ◽  
Content Type ◽  
Recent Developments ◽  
Protection Legislation ◽  
Adult Protection

Purpose – The purpose of this paper is to compare recent developments in adult protection legislation, policy and practice in Scotland in 2015 with the first attempts at protection of adults at risk of harm, in 1857-1862, with a particular focus on people with learning disabilities. Design/methodology/approach – The paper uses comparative historical research, drawing on primary archive material from 1857 to 1862 in the form of Annual Reports of the General Board of Commissioners in Lunacy for Scotland and associated papers. Findings – Growing public awareness of the extent of neglect and abuse, and the need for overarching legislation were common factors in the development of both the “The Lunacy Act” of 1857 and the Adult Support and Protection (Scotland) Act of 2007. Both pieces of legislation also had the common aim of “asylum”, and shared some other objectives. Practical implications – Total prevention of abuse of vulnerable adults is an aspiration in law and in policy. There is an evidence base of effectiveness, however, in protecting adults at risk of harm from abuse. Some ecological factors recur as challenges to effective safeguarding activity. These include problems of definition, uncovering abuse, enforcing legislation, evaluating impact and protection of people who are not a risk of harm to others. Originality/value – This paper compares common themes and common challenges in two separate time periods to investigate what can be learned about the development of legislation and practice in adult protection.

scholarly journals Carers and co-production: enabling expertise through experience?

2015 ◽  
Vol 20 (4) ◽  
pp. 232-241 ◽  
Author(s):  
Eleanor Bradley
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Family Members ◽  
Mental Healthcare ◽  
Service Users ◽  
Content Type ◽  
The Impact

Purpose – The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design/methodology/approach – The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings – Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research limitations/implications – Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical implications – Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social implications – The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise. Originality/value – This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”.

Positive risk taking: debating the research agenda in the context of adult protection and COVID

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Erin King ◽  
Karen Davies ◽  
Michele Abendstern
Keyword(s):  
Risk Taking ◽  
Research Agenda ◽  
Social Care ◽  
Empirical Studies ◽  
Service Users ◽  
Content Type ◽  
Health And Social Care ◽  
Professional Perspectives ◽  
Safety First ◽  
Adult Protection

Purpose The purpose of this paper is to present the case for examining the concept of positive risk taking (PRT) in the context of adult protection. The paper argues there is a need for empirical research to understand the application of and attitudes to PRT to explore whether the concept has moved beyond a principle to make an identifiable difference to service users. Design/methodology/approach By investigating evidence from policy, literature and professional opinion, this paper presents the ethical tensions for professional practice in adult protection between respecting a service user’s freedom to make choices to enhance their independence while preserving safety for service users and society. This is considered in the context of risk in health and social care and the recent changes in society resulting from COVID-19. Findings Inherent tensions are apparent in the evidence in health and social care between attitudes propounding safety first and those arguing for the benefits of risk taking. This indicates not only a need for a paradigm shift in attitudes but also a research agenda that promotes empirical studies of the implications of PRT from service user and professional perspectives. Originality/value This paper draws attention to the relatively limited research into both professionals’ and service user’s perspectives and experiences of PRT in practice.

Call of duty: an exploration of the factors influencing NHS professionals to report adult protection concerns

2016 ◽  
Vol 18 (3) ◽  
pp. 161-171 ◽  
Author(s):  
Kate Fennell
Keyword(s):  
Health Professionals ◽  
Health Condition ◽  
Research Strategy ◽  
Small Scale ◽  
Structured Interviews ◽  
Related Factors ◽  
Content Type ◽  
Reporting Decisions ◽  
Adult Protection ◽  
Adult Support

Purpose – The Adult Support and Protection (Scotland) Act 2007 places a duty on Councils to investigate the circumstances of adults who, because of a disability, health condition or illness are unable to safeguard themselves from harm. Public partner agencies, including the NHS have a statutory obligation to bring to the attention of the Council those individuals who may be at risk of harm. Health professionals cooperate with adult protection investigations and participate in the development of adult support and protection plans, yet do not appear to be initiating adult protection referrals with the Council. Low reporting by health has also been recognised as a national issue. The purpose of this paper is to explore what promotes and what prohibits the identification and reporting of situations of abuse within the Scottish Legislative Framework. Understanding the decision-making processes of prospective reporters would potentially allow the barriers to be reduced and the supports to be strengthened. Design/methodology/approach – The research strategy is based on a literature review, a web-based survey and semi-structured interviews with health professionals within community learning and community mental health teams. Findings – The findings point to a number of inter-related factors which impinge upon the professional’s confidence to initiate adult protection referrals. Workers must first recognise harm as conduct which needs to be reported and addressed. They need to be familiar with referral procedures and be assured that their concerns will be dealt with appropriately. Health professionals are more likely to report if they are based in an environment which supports honest and open discussion regarding harm, without over-concern about agency reputation or resources. Access to multi-disciplinary consultation and support, particularly in relation to more ambiguous protection situations, was viewed as fundamental to reporting. Originality/value – This small scale study adds to a developing bank of literature providing a Scottish perspective on protecting adults. It offers some insight into reporting decisions from the viewpoint of community health professionals.

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