As Director of the National Centre for Post-Qualifying Social Work and Professional Practice (NCPQSW), Professor Keith Brown’s work looks at how medical consent is given in times of need, as well as how scamming has become especially prevalent in the elderly and those living with dementia.
"BU’s National Centre for Post Qualifying Social Work gained its title about ten years ago because we at BU were deemed to be the leaders in our field. We have had over 20,000 qualified professionals coming through our centre as students, since the centre was created in 1999. When people are sectioned under the Mental Health Act, this can only be done by somebody called an Approved Mental Health Professional, and we train a quarter of these in the UK, as well as producing most of the text books used for studying in this field.
"We’ve also become even larger in the area of mental capacity, which is not just about consent for treatment; it’s also about safeguarding people who lose capacity and who may have their liberty deprived under the mental capacity act. For example, if someone has dementia and is in a care home which has a door with a lock on it, to prevent a resident from running across the road, this cannot be done without providing safeguards, because the person can’t object. They do not have the capacity to make an informed choice.
"We’ve written the main training texts around the Mental Capacity Act and train a third of all of Best Interest Assessors, these are social workers, nurses, occupational therapists or psychologists who assess when somebody who has lost their capacity, in order to make sure that any deprivation of their liberty is appropriate. This safeguarding measure ensures that people’s liberty is deprived appropriately, not just to suit a hospital, a doctor, care home or others."
"About six years ago, we produced the national safeguarding framework for adults, used by most health organisations and local authorities in the country. This was put into its third edition in 2014 when the Care Act came about, so we are quite big in the area of safeguarding too.
"However, the Centre doesn’t just look at legislation surrounding mental capacity and mental health. Because of our expertise in mental capacity and safeguarding, we were asked by financial fraud experts, the Chartered Trading Standards Institute (CTSI) and the National Scams Team, to help advise them about how to understand the particular vulnerabilities of citizens of who have a cognitive impairment such as dementia. Although experts in catching criminals and stopping financial fraud, they realised that it was predominantly elderly people and those in the early stages of dementia that are affected, so they ask for our help and this is how we ended up leading national research in this field.
"Our ‘safeguarding adults’ textbook won an institutional hero award from the CTSI in 2017 in recognition of the impact of our research in this area. A copy was issued to all trading standards departments and the chairs of every safeguarding board in the England as national guidance. We’ve continued to research and publish guidance in those areas, as well as writing the guidance on next of kin and advanced decisions to refuse treatment."
Another area of interest for the team has been the repeated use, throughout the healthcare professions and society, of the phrase ‘next of kin’.
"The term next of kin is actually meaningless in law – the only time the law mentions this is if someone was to die without a will. When you go to hospital, ‘next of kin’ is often asked for on forms, but the questions should really be, who should be contacted in the event of your death? The Mental Capacity Act makes provisions for decision making with something called a lasting power of attorney, which allows someone to act on your behalf if you no longer have the capacity to do so, so that they can legally act on your behalf.
"Often, lasting power of attorney is used in cases of dementia, but it could be an 18 year old who has fallen off of his motorbike, has a head injury and cannot speak for himself. The parents may think that because they are the parents, they can legally intervene and have a say about what will happen regarding life support, but in actual fact, they can’t. Health services will listen, but these parents do not have a legal right. A lasting power of attorney allows you to register people to speak on your behalf, which gives people the same rights as if it was yourself.” There are two forms of lasting powers of attorney- Property and Affairs, and Health and Welfare. You can register either of both, and our guidance in these areas is widely used.
"Our work is so important because it’s about the most vulnerable people in society, whether it is children in care or older vulnerable people, we look at how we can take that expertise into the world of health so that, in an NHS where people increasingly don’t get better through chronic conditions and being elderly and frail, people’s end of life care is managed and families are able to think through things like resuscitation, life support, mental capacity, and protecting the vulnerable from criminals who are trying to scam them.
"What we do now know is that people who are defrauded of their life savings often feel badly violated and lose their confidence to live in the community. If someone has been conned, they often lose the confidence to maintain themselves at home at thus they end up in residential care as they are simple to afraid to remain at home. The family also feel terrible because they’ve not been able to protect their loved one from being conned. This is a cycle of pain and grief, and trying to stop it is critical.
"We’ve discovered via research in the last few years that the most vulnerable in our society are lonely elderly people – we meet these people through our research and surprisingly some of them are so desperately lonely that they are prepared to be scammed simply to have contact with the outside world. They know they are dealing with fraudulent scam mail; but they would rather have that mail than no human contact at all.
"We’ve also worked with other vulnerable people to provide call blocking devices and some of them have switched them off, because prior to installing the device, they received 30 calls a week, and they’d rather the five calls a day from a scammer than no calls at all. You find yourself looking into the whole arena of loneliness and how society is dealing with loneliness, which has become a major issue for healthcare and social services.
"Interestingly enough, our work will be making an impact on the BU community itself and their own families. If someone in the south of England has a family member with a mental health crisis and needs to be detained under the mental health act, it is likely one of our graduates that is going to be working with them - there are not many working in this field that we haven’t trained. It affects our own community, but people don’t perhaps realise that it is us at BU that are helping their families and elderly relatives through our work."
For more information about the National Centre for Post Qualifying Social Work, visit http://www.ncpqsw.com/