I’m sure this is the same for everyone, both in their lives and their careers, but I've found that there are certain events that stay with you for some unknown reason. On these rare occasions you are left with an indelible mark that stays with you, which from time to time you find yourself glancing at again. One such event from several years ago is the story of Freda. I recently heard news about her death so I suppose it's inevitable that my mind turns once again to her. It’s a brutally sad story, which is perhaps why it affected me – and continues to do so – but more than that I feel that the story crosses well into tragedy if the lessons are not learned from what happened.
I don’t think that Freda's is necessarily a simplistic story about the innate dangers of cutting social budgets. Nor do I think it’s a story about apportioning blame. It’s possibly more of a story about a shift that I would like to see (potentially enabled by the Big Society) towards a point where organisations share their unique view of a situation to build up a more omniscient view that potentially could prevent such things from happening. Perhaps it makes an eloquent case for housing always to be a required presence on the new Health and Social Care Boards being established round the country. Perhaps it’s just a sad story.
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Two women had lived as neighbours in the same block of flats for a decade. One was in her eighties and was open, gregarious, well-liked and respected for her community work. The other, Freda, was in her sixties and had been described by her doctor as “being a bit odd”. Her neighbours shared that view, as they regularly faced some challenging behaviour from her and some unpleasant odours from what was a poorly managed tenancy. Whilst this behaviour was for the most part tolerated, comments were occasionally made to Freda about the fact that she was disruptive and smelly.
Now the older woman lies dead. Some hours earlier, Freda had used an empty plastic bottle to hit her on the back of her head. Initial injury was slight, but a heart attack came swiftly afterwards, from which she never recovered. The post-mortem shows no direct causal relationship between the assault and the heart attack, so no murder; just an assault with terrible, tragic consequences.
As always at times of crisis, the full forces of the caring professions were mobilised. Housing staff, police, social workers, psychiatrists, district nurses, community psychiatric nurses all working in partnership to make the best of a messy situation. Over the initial few days, hours of professional time was consumed, the value of which inevitably ran into thousands of pounds.
Freda showed no remorse for her actions “I’d do it again… she had it coming…she was the ringleader of them against me,” she said. She showed no understanding of her bail condition which prevented her from returning to her flat, threatening suicide if she wasn’t allowed to go back. She flatly refused to engage with any of the support that was offered to her.
After one night in emergency accommodation, the psychiatrist didn’t consider that she could be detained under mental health legislation and so the professional team as a whole had no power to prevent her returning to her old flat. Fortunately, an assessment bed was found at a residential care home and Freda spent her second night there. But she was distressed about being unable to return to her own flat, aggressive towards those who were trying to help her and the danger of disruption in her new setting remained ever-present.
Had anyone seen it coming? Was it inevitable or could anything have been done to prevent it?
Her doctor had known her for twenty years and attached the label of “personality disorder” to her behaviour – something that MIND labels as a “dustbin diagnosis”; a catch-all with little real meaning or value. But did his long-standing relationship with her mean that he been unable to see her deteriorating ability to look after herself? The District Nurse who visited every day was satisfied that she was self-medicating adequately, including for her insulin dependency. But were the worsening condition of her flat and Freda’s increasing frailty on her radar?
The community psychiatric team had assessed her more than once and despite her erratic behaviour and the impact it was having on others, had not felt her to be in need of intervention. The housing staff, sympathetic to the vulnerability that Freda so clearly displayed, were reluctant to take action to enforce (through taking her home away if necessary) the tenancy conditions which she was required to comply with.
All the individual pieces of Freda’s jigsaw were there but through no one’s fault there was no system to put them together and see the bigger picture. Each professional dutifully looked at their specific part of the picture. They did nothing wrong, but had anyone stood far enough back to look at the big picture, they would have seen a vulnerable woman who was simply not able to live an independent life without a well-thought out bespoke care plan. They would have seen someone who was not getting the help she needed and was potentially a threat to herself and, as it so tragically turned out, to others too.
Freda’s story illustrates a much wider problem with social care across the country where public service budgets – for domiciliary support, mental health interventions – are stretched and continue to be pulled tauter still. It is fanciful to expect that those budgets will be increased in order to prevent further tragedies like this. If “community care” has failed both Freda and her victim, the answer is not to return to the institutional incarceration of the mental hospital.
It’s potentially not more money that we need to improve the millions of other situations and lives like Freda’s that are balanced on a knife’s edge. Maybe what is needed is to develop our understanding of the broader picture, so we can all listen and respond to the concerns of our fellow professionals. Perhaps we need to develop new skills and systems for sharing our knowledge about vulnerable people across organisational boundaries. Above all, we need to recognise that resources invested in prevention save on those required at times of crisis and potentially save people’s lives too.
I don’t think that Freda's is necessarily a simplistic story about the innate dangers of cutting social budgets. Nor do I think it’s a story about apportioning blame. It’s possibly more of a story about a shift that I would like to see (potentially enabled by the Big Society) towards a point where organisations share their unique view of a situation to build up a more omniscient view that potentially could prevent such things from happening. Perhaps it makes an eloquent case for housing always to be a required presence on the new Health and Social Care Boards being established round the country. Perhaps it’s just a sad story.
************
Two women had lived as neighbours in the same block of flats for a decade. One was in her eighties and was open, gregarious, well-liked and respected for her community work. The other, Freda, was in her sixties and had been described by her doctor as “being a bit odd”. Her neighbours shared that view, as they regularly faced some challenging behaviour from her and some unpleasant odours from what was a poorly managed tenancy. Whilst this behaviour was for the most part tolerated, comments were occasionally made to Freda about the fact that she was disruptive and smelly.
Now the older woman lies dead. Some hours earlier, Freda had used an empty plastic bottle to hit her on the back of her head. Initial injury was slight, but a heart attack came swiftly afterwards, from which she never recovered. The post-mortem shows no direct causal relationship between the assault and the heart attack, so no murder; just an assault with terrible, tragic consequences.
As always at times of crisis, the full forces of the caring professions were mobilised. Housing staff, police, social workers, psychiatrists, district nurses, community psychiatric nurses all working in partnership to make the best of a messy situation. Over the initial few days, hours of professional time was consumed, the value of which inevitably ran into thousands of pounds.
Freda showed no remorse for her actions “I’d do it again… she had it coming…she was the ringleader of them against me,” she said. She showed no understanding of her bail condition which prevented her from returning to her flat, threatening suicide if she wasn’t allowed to go back. She flatly refused to engage with any of the support that was offered to her.
After one night in emergency accommodation, the psychiatrist didn’t consider that she could be detained under mental health legislation and so the professional team as a whole had no power to prevent her returning to her old flat. Fortunately, an assessment bed was found at a residential care home and Freda spent her second night there. But she was distressed about being unable to return to her own flat, aggressive towards those who were trying to help her and the danger of disruption in her new setting remained ever-present.
Had anyone seen it coming? Was it inevitable or could anything have been done to prevent it?
Her doctor had known her for twenty years and attached the label of “personality disorder” to her behaviour – something that MIND labels as a “dustbin diagnosis”; a catch-all with little real meaning or value. But did his long-standing relationship with her mean that he been unable to see her deteriorating ability to look after herself? The District Nurse who visited every day was satisfied that she was self-medicating adequately, including for her insulin dependency. But were the worsening condition of her flat and Freda’s increasing frailty on her radar?
The community psychiatric team had assessed her more than once and despite her erratic behaviour and the impact it was having on others, had not felt her to be in need of intervention. The housing staff, sympathetic to the vulnerability that Freda so clearly displayed, were reluctant to take action to enforce (through taking her home away if necessary) the tenancy conditions which she was required to comply with.
All the individual pieces of Freda’s jigsaw were there but through no one’s fault there was no system to put them together and see the bigger picture. Each professional dutifully looked at their specific part of the picture. They did nothing wrong, but had anyone stood far enough back to look at the big picture, they would have seen a vulnerable woman who was simply not able to live an independent life without a well-thought out bespoke care plan. They would have seen someone who was not getting the help she needed and was potentially a threat to herself and, as it so tragically turned out, to others too.
Freda’s story illustrates a much wider problem with social care across the country where public service budgets – for domiciliary support, mental health interventions – are stretched and continue to be pulled tauter still. It is fanciful to expect that those budgets will be increased in order to prevent further tragedies like this. If “community care” has failed both Freda and her victim, the answer is not to return to the institutional incarceration of the mental hospital.
It’s potentially not more money that we need to improve the millions of other situations and lives like Freda’s that are balanced on a knife’s edge. Maybe what is needed is to develop our understanding of the broader picture, so we can all listen and respond to the concerns of our fellow professionals. Perhaps we need to develop new skills and systems for sharing our knowledge about vulnerable people across organisational boundaries. Above all, we need to recognise that resources invested in prevention save on those required at times of crisis and potentially save people’s lives too.
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