Text size: a | a | a

Findings from our analysis of Mental Health Officer records of guardianship supervision visits

As part of our research we looked at the standards of Mental Health Officer (MHO) report writing and the quality of recording of supervisory visits/ contacts. A total of 47 reports were scrutinised of which 36 reports were completed for private guardianship applications and the remainder for local authority applications. Only one MHO did not support a private guardianship application in their report. We assessed each report against a number of criteria and noted any additional comments relevant for the purposes of the study.

MHO reports for private guardianship applications

Whilst all the reports supported all the powers sought, very few commented on powers individually, why they were necessary and in what way the person would benefit from them. We saw little exploration of the need for specific powers that would demonstrate practice consistent with the principles of the Act.

Most of the reports provide social background information but the overall standard of reporting on social circumstances is poor. In some cases there is no information provided and in others there is sketchy detail. In several reports the MHO makes reference to the person transferring from child to adult services and the need for decision making powers but offers no information on the person's circumstances to make this statement meaningful.

Most reports do not address the question of what alternatives were considered and deemed to be inappropriate. A number refer to informal arrangements being used up until the point of applying for guardianship but do not explain why formal arrangements are now necessary.

We found a lack of detail provided regarding how the person's mental disorder impacts on their capacity in terms of their day to day functioning and how this relates to the need for safeguards to enable decisions to be made, or actions to be taken, on their behalf.

Most reports demonstrate that a lot of effort is made to ascertain the views of the person and, where unable to do so, provide evidence of what attempts have been made to try and obtain these. Similarly, a great deal of effort is invested in establishing the views of others with an interest in the person and detailing these in the report.

MHO reports for local authority guardianship applications

In contrast to those provided for private applications, the majority of MHO reports for local authority applications outline alternatives and discuss why these interventions would be inappropriate. A number of reports, however, provide no evidence of what alternatives have been considered.

Some of the reports argue very clearly as to why guardianship would benefit the individual. They specify the risks to the person and /or others and the level and type of protection provided by each of the powers being proposed.

A number of reports give very detailed social background information. In order to understand the reasons for applying for guardianship, it is important to consider the social factors that influence decisions to seek protective measures in relation to vulnerable individuals.

As is the case for private guardianship applications, the majority of reports indicate that the MHO has made a great deal of effort to ascertain the views of both the adult and others with an interest in the person. In situations where they were unable to ascertain views, there was generally a clear explanation on efforts that had been made to obtain these views.

 Overall the reports for local authority guardianship applications were considered of a higher standard than those completed for private applications. Generally they provided more detailed social background information and a more reasoned argument for why the order was needed. In the reports that considered alternatives, there was a much more in-depth exploration of these and why they were not considered an appropriate intervention.

Social work notes covering the exercise of statutory functions

A total of 40 copies of notes covering the exercise of statutory functions as either supervising or responsible officer were requested. Despite reminders being sent out when notes were not received, only 32 sets of notes were submitted. Of those received, we did not include two sets of notes in the survey as they related to visits and contacts made over a period outwith the dates requested. Of the 30 sets of notes included, 19 related to private cases and 11 to local authority cases.

Visits to guardians and adults on guardianship

Of the 19 private cases, 14 indicated that at least the required two visits had been made to the guardian in the 12 month period specified, however, in one case both visits were made in December 2007. The remaining five recorded a single visit in the period. Only 6 of the notes submitted recorded any visits to the person on guardianship.

The local authority cases involved only visits to the person on guardianship. Eight of the eleven sets of notes recorded at least the required two visits having been made in the period. One worker recorded a single visit in the period. Two reported no visits.

In a quarter of the cases, in which the Chief Social Work Officer had been appointed welfare guardian, the relevant notes relating to the management of the guardianship could not be produced by social work staff. In a further quarter of the cases there was no evidence from the case records that the minimum statutory visiting requirements were being met.

In an additional fifth of these cases there was no record of any statutory visit to the adult on guardianship being undertaken. This means that in nearly three-quarters of those cases in which the Chief Social Work Officer was appointed guardian, there was no record made available to us of the statutory visiting requirements being met by the responsible officer on behalf of the Chief Social Work Officer. This finding causes significant concern about governance arrangements in place regarding actions taken on behalf of the Chief Social Work Officer.

Case notes recorded the minimum requirement for statutory visits by the local authority supervising officer to the adult on welfare guardianship where there was a private guardian in under a third of the cases.

In contrast, statutory visits to private guardians were recorded in 68% of the cases. Half of the notes received did not specifically state how the statutory functions of local authority officers were being carried out. In these cases the notes related solely to the care management role, detailing the worker's involvement in undertaking social work tasks.

Eight copies of care review meeting minutes we reviewed made little or no explicit reference to use of guardianship powers. Pro formas are used by some local authorities to record guardianship interventions, where these are in place we found they provided much clearer information for local authorities to review how they are carrying out their statutory functions under guardianship - making reference to use of powers, impact of changes in circumstances and whether the order is still necessary.

In general, there was a lack of clear information indicating whether supervisory contact/visits to the adult in relation to private guardianship cases were, in fact, undertaken.

Some of the case notes distinguish between the care management and guardianship roles. In most cases, however, it was difficult to extract this information from the case notes. Although the quality of the recording was very variable, where a template is used for recording, the remit of the worker in monitoring and reviewing guardianship is much easier to identify. The pro forma used in West Lothian for reviewing guardianship was considered as particularly helpful as a means of addressing key areas including assessment of use of powers, need for existing, additional powers, evidence of principles of the Act being observed and actions required, with the names of persons responsible for carrying out actions with completion dates.

In one set of notes, the supervising officer records a home visit to the adult and private guardians, referring to the need for renewal of the order for an indefinite period without evidence of the need or explanation of the rationale behind this proposal. In another, the private guardian refers to the need for renewal of the order in a care review meeting but the notes do not record what, if any, discussion took place as to why this was necessary.

Information provided to care staff about welfare guardianship powers

When an adult on welfare guardianship is resident in a care home, most authorities provide the care home with a copy of the order and information on the powers. This only seems to happen where the local authority has made the application. This information may also include a copy of the care plan. Reference was also made to the issuing of a copy of the Mental Welfare Commission guidance LINK "Working with the Adults with Incapacity Act in Care Homes".LINK

Some authorities saw it as the responsibility of the private guardian to provide this information and were advised to do this by the care manager/MHO. However, respondents expressed concerns that this did not always happen.

We believe it is essential that care staff are aware of the legal status of their residents and should know what powers have been granted under guardianship. We would expect that when the powers of the guardian are to be delegated that there is a meeting to formally decide which of these powers are to be delegated, to whom they are to be delegated and the circumstances in which they are to be delegated. When the guardian should be contacted for consultation or notification should be detailed as well.

Local authority supervising officers should offer to assist private guardians in this process where necessary.