Chapter 5: Adult Participation
1. This chapter discusses the principle of ensuring that full regard is given to the wishes of the adult; and the principle of the adult participating as fully as possible in all aspects of the adult protection process. It also covers the importance of providing advocacy and other services.
2. The adult's views and wishes are central to adult support and protection, and every effort should be made at each stage of the process to ensure that barriers to the adult's participation are minimized. Undue pressure on the adult from another party is one barrier which can occur. It would be good practice to consider the best ways to check at various stages with the adult how included they feel and ensure they have the opportunity to highlight if they feel excluded at any point. All records should be made available to the adult and decisions explained.
3. The adult should be provided with assistance or material appropriate to their needs to enable them to make their views and wishes known. Reasonable adjustments should be made to support the adult's needs wherever identified. The communication needs of the adult should be considered and the adults should be asked what support if any they wish. It may be that they wish assistance from a relative or primary carer. They may wish a particular format for communication. This could be technical aides to support communication or information to be interpreted, translated or adapted. It could be translation for persons whose first language is not English. The Royal Society of Speech and Language Therapists has developed a set of principles, standards and practical guidance for ensuring that an individual is enabled to understand and communicate effectively:
The Office for Disability has guidance for alternative formats of communication:
4. Other aids and adaptations that can support and enable communication include British Sign Language interpreters, lip speakers, Makaton, and deaf-blind communicators. Where possible, materials should also be available in alternative formats such as large print, audio tape, Braille and computer disc. Consideration should also be given to the surrounding environment. This can affect communication due to, for example, noise levels, provision of loop systems or lighting. These are just some examples of areas that should be taken into consideration.
Independent advocacy services
5. Section 6 of the Act places a duty on the council, if it considers that it needs to intervene after making inquiries under Section 4 of the Act, to protect an adult at risk of harm, and to have 'regard to the importance of the provision of appropriate services including independent advocacy services to the adult concerned'. Independent advocacy aims to help people by supporting them to express their own needs, gain access to information, understand the options available and make their own informed decisions.
6. The adult should be asked if they know about and would like advocacy. Where advocacy is offered, declined by the adult or not deemed appropriate, the reasons for this should be clearly recorded, as should the reasons for not referring to any other 'appropriate' services. This decision should be re-visited and recorded at each formal review e.g. multi-agency meetings, review or professional meeting.
7. The Mental Health (Care & Treatment) (Scotland) Act 2003 Section 259 ("the 2003 Act") states that:
"Every person with a mental disorder shall have a right of access to independent advocacy; and accordingly it is the duty of -
a. each local authority, in collaboration with the (or each) relevant Health Board; and
b. each Health Board, in collaboration with the (or each) relevant local authority, to secure the availability, to persons in its area who have a mental disorder, of independent advocacy services and to take appropriate steps to ensure that those persons have the opportunity of making use of those services.
8. The definition and the principles of independent advocacy services used in the Act is that given in Section 259 of the Mental Health (Care and Treatment) (Scotland) Act 2003 and Code of Practice Volume 1. This states that:
- independent advocacy providers cannot be involved in the welfare, care or provision of other services to the individual for which it is providing advocacy
- independent advocacy should be provided by an organisation whose sole role is independent advocacy or whose other tasks either complement, or do not conflict with, the provision of independent advocacy
9. Advocacy safeguards people who are vulnerable and discriminated against or whom services find difficult to serve. For further information about advocacy, please refer to the Scottish Government Guide for Commissioners and the Scottish Independent Advocacy alliance (refer Annex B no 19).
10. Under Section 41(6) of the Act, the sheriff has discretion to appoint a person to safeguard the interests of the affected adult at risk in any proceedings relating to an application under the Adult Support and Protection (Scotland) Act 2007. It may be that the sheriff will instruct the safeguarder to report on the issue of consent.
Appropriate adult schemes
11. The role of the appropriate adult is to facilitate communication between a mentally disordered person and the police and, as far as is possible, ensure understanding by both parties. The use of an appropriate adult is extended to all categories of interview - witness, victim, suspect and accused. Appropriate adults are selected for their experience in the field of mental health, learning disabilities, dementia and/or acquired brain injuries. It is their role to pick up on clues and indicators that a person has not fully understood what they are being told or what they are being asked. The appropriate adult is not providing advocacy or speaking on behalf of a person with a mental disorder, but is about an independent third party checking that effective communication is taking place and that the person being interviewed is not disadvantaged in any way due to their mental disorder. In the context of a criminal investigation an advocacy worker would not be present. Further information can be obtained from: www.scotland.gov.uk/Topics/Justice/law/victims-witnesses/Appropriate-Adult
Meetings of agencies with the adult at risk.
12. If the fullest possible participation of the adult at risk in supporting and protecting them from harm is to be achieved, he or she needs to be included in the best way taking into account their needs and capacity, in all decision-making processes about their support and protection. Good practice in adult protection is no different from good practice in other areas such as care and treatment of mental illness, self-directed support, or commissioning of services to meet assessed individual needs.
13. Thus the adult at risk should (unless it is considered not to be in their best interests) be invited to and involved in setting up of meetings to consider risks to which they are exposed and how best they can be protected or enabled to make informed decisions concerning potential risks. If they are not invited the reason should be recorded and communicated to the person in a format she or he can understand along with a method for the person to appeal the decision provided.
14. It should be the responsibility of the relevant adult protection practitioners to ensure that the adult has been invited to meetings, that they are involved to maximise the likelihood of their attending (for example by provision of information, by choice of venue, day/time, number of other attendees, video conference options, and travel arrangements); and that they get the best from the meeting through their participation and contribution to decisions (through pre meetings to fully explain the purpose, plan agenda and options, discuss concerns re confidentiality, consider language and communication needs, advocacy or other representation). The main aim is to assist the adult to understand the purpose of the meeting, their role within it and their participation.
15. 'Working Together in Adult Support and Protection - Views and Tools of People who Access Support': http://www.thistle.org.uk/sites/default/files/publication-files/altrumreport.pdf provides advice on preparing for and holding meetings with an adult potentially at risk. Adult Protection Committees are encouraged to utilise this document in training staff on engaging adults at risk of harm and preparing for and holding meetings of the adult and agencies.
16. There will be occasions and circumstances where it is not in the adult's best interest to attend large multi-agency meetings or they do not wish to attend, due to illness or incapacity for example or where matters of great sensitivity will be explored (such as other possible victims, or the identity of the perpetrators). It may be that such a meeting would be intimidating or distressing for an already distressed or traumatised adult. Support and information should be offered to the adult and as appropriate their carer/family or relative to assist with the options and decision to attend.
17. The adult also has the right to refuse to attend, despite the best efforts at support and encouragement. It is important that the adult does not feel pressurised, however the possibility of undue influence affecting the adult's hesitancy to participate should be considered. In all cases where the adult is not attending the views of the adult should be sought and recorded in advance of the meeting and another individual should represents those views such as an advocacy worker or other designated person. The reason for the adult not being present needs to be recorded as part of the minute of the meeting and alternative methods identified for explaining fully to the adult what options were considered, what decisions were taken and why.
18. Local procedures should include that the allocated adult support practitioner should offer to visit the adult and carer where it would be in their best interests after any meeting. This is to reflect on what happened, ascertain whether they understood the process and outcomes of the meetings; and to ascertain whether any issues remain unaddressed or new issues have arisen.
19. The Act (in section 2(c)) stresses the importance of the views of the adult's nearest relative, primary carer and any guardian or attorney. The steps described above will help to meet this standard.
20. However, it will always be important to distinguish between the needs and perspectives of each person. There may be conflict between the needs of the adult and the carer due to differing perspectives and needs which will both require to be taken into account by workers throughout the adult support and protection process.
21. It may be that someone in a caring role or a guardian can cause harm intentionally or unintentionally, by using their power inappropriately, exerting undue pressure or they can be the victim of harm. There may be significant complexity in a relationship creating the potential for both parties to be both victim and harmer at different times.
22. In both situations, considerable skill and patience will be needed, and information and assessments for both the carer and cared for person will need to be carefully considered in multi-agency meetings. Some carers, especially the most vulnerable may have needs for support in communication and/or may benefit from independent advocacy support. The carer advocacy worker will be independent of any advocacy worker for the cared for person and will represent the carer as a distinct voice from that of the person being cared for. The advocacy worker(s) may assist in considering and assessing any conflict of interest; for example, the cared for person may attempt to influence the views they wish the carer to express, and vice versa.
23. Caring often has a significant impact on a carer's health and wellbeing. It may be that the adult's carer requires support to sustain their caring responsibilities (thus preventing any unintentional stress related harm) and to lead a life alongside caring. The Community Care and Health (Scotland) Act 2002 gives carers providing regular and substantial care a right to an assessment of their needs. Councils have a duty to inform carers of this right to an assessment and it would be good practice to reassess needs as the caring role changes. It would also be good practice to provide any carer, with information about local carer centres and condition specific groups that may be able to provide support, information and advice.
Vulnerable Witnesses (Scotland) Act 2004
24. The Vulnerable Witnesses (Scotland) Act 2004 provides support measures to help vulnerable adults participate more fully in court proceedings. The measures are intended to help vulnerable witnesses by providing appropriate support when they give their evidence to reduce any anxiety and pressure. The procurator fiscal should fully consider alternative ways of the adult providing evidence. Further information is available at:
25. Adult Protection Committees should consider regular audits of the extent to which adults are enabled to participate fully in decision making, for example monitoring the number of meetings which adults at risk are invited but do not attend, auditing the recording of reasons why and including questions about this issue in regular audits of the experience of being protected. Uptake of advocacy services should also be included.
Email: Stephanie Robin