Helping Steven

What was the person’s situation before working with Advocacy Focus?

Steven was homeless and living on the streets when he took a near fatal overdose, which left him on life support. Hospital staff struggled to identify him and had no knowledge of his family and friends. 

Professionals had an important and challenging decision to make; whether to withdraw Steven’s life support or not. They were almost certain that by doing so, he would pass away within a few days.

A referral was made to Advocacy Focus under the Mental Capacity Act. The Mental Capacity Act requires doctors to involve an Independent Advocate for serious medical treatment decisions under certain circumstances. Such as when the person lacks the capacity to consent or when they have no family and friends with whom it is ‘appropriate to consult.’

As our Advocate was unable to ascertain Steven’s views and unable to contact any family members, they decided to check that the relevant protocol was being followed, in particular in relation to the Mental Capacity Act, and immediately instructed legal advice.

However, whilst the Advocate was awaiting legal advice, the decision was made by the hospital to withdraw Steven’s life support.

Fortunately, within a few days of withdrawing his support, Steven began to improve and was later discharged into a nursing home. Our Advocate continued to work with Steven as his Relevant Person’s Representative and to help him understand and challenge his Deprivation of Liberty Safeguards authorisation (DoLS).

There were several conditions written into Steven’s DoLS authorisation, ensuring that he had access to physiotherapy, a speech and language team, and access to the community.

DoLS meaning – When caring for someone, it is sometimes necessary to restrict their freedom or independence to keep them safe – for example, a person with dementia may not be allowed to leave a care home, as this would put them in danger. Sometimes, however, DoLS authorisations are not always necessary and we may have to challenge these.

How did we help?

Steven was fed through a feeding tube and had difficulty communicating, because of this his behaviour was often seen as challenging and he had regular emotional outbursts. He also needed restraining when being cared for.

Our Advocate regularly visited Steven in an attempt to get to know him and try to understand his views on his living and caring arrangements. After the second visit, it was clear that Steven was not happy with some of his restrictions.

What was the outcome?

As a result, our Advocate worked with Steven’s carers to:

• Ensure all the relevant referrals to physiotherapy and speech and language were completed timely and efficiently; as a result, Steven started to regain some of the strength back in his legs
• Start having tasters of food instead of through his feeding tube, which was a big step for him
• Explore options for more stimulating activities inside and outside of the nursing home
• Ensure that he was being hoisted to the toilet as per his wishes
• Ensure a care plan was put in place for his future goals
• Set Steven up with our communications toolkit, to help him communicate his needs and wishes with his carers at any time.

Once Steven had been listened to and felt he was communicating better; his behaviour began to change. Now, he no longer needs physical restraint when being cared for. His emotional and social wellbeing also appear to have improved and his emotional outbursts have become much less frequent.

Why was advocacy support so effective?

Advocacy helped aid Steven’s recovery, by ensuring he was supported and cared for in the way he wanted despite his ongoing communication difficulties. Steven’s recovery is still ongoing, but he is generally much happier with his living and caring arrangements.