Mental vulnerability & risk Dr Peter Jefferys Consultant Psychiatrist Norfolk & Suffolk NHS FT CenTSA Conference 27 Sep 2016
Desired outcomes: Improved understanding of: Nature of trust Victims & mental vulnerability Who Why How Perpetrators
Case study 1 – P widow living alone Independent minded then minor stroke Priest introduction to carer Neighbours excluded neighbours P nominated carer as: EPA attorney / DWP appointee Sole beneficiary (Will) Owner of home ‘Rescued’ by police 3yrs later P begged to return to carer Mental health assessment (in care) showed dementia Court of Protection (residence & care) then CPS prosecution
Case study 2 – R recent widow Dependent on wealthy husband Cousin executor (solicitor) assisted with purchase of new home Became attorney (EPA) Old friends excluded Friend witnessed R signing blank cheques 2 yrs later Investigation (COP) revealed New home + classic car owned by cousin Multiple cash transfers to cousin Cousin main beneficiary (new Will) Cousin’s legal firm in debt Capacity assessment showed significant dementia Fraud investigation following expert report
Who can we trust? Personal Professional / quasi professional Close family Select friends / work colleagues / neighbours Professional / quasi professional Doctors, nurses etc. Familiar tradespeople Solicitors Policemen Social workers Care workers (home / residential)
Gaining trust: ‘Trust me, I’m a doctor’ Prepare: Look smart & clean Respectful Homework Chat-up: Compliment dress / appearance Photos, home possessions Family / life story / achievements Common ground Grooming: extra time Treats excessive dependency
Victim risk factors Demographic Dependency Living alone / cultural / social isolation Loss Partner Home Mobility Vision Hearing Dependency Food prep., cleaning, laundry Personal care, feeding, toileting, washing / bathing, medication Finances – shopping / bills / pensions etc. Emotional support
Causes of mental vulnerability Transient (common) Acute trauma (physical / psychological) Impaired awareness (e.g. anaesthetic, drugs) Alien environment – physical/social/disorientation Impaired cognition (memory, concentration, intellect etc.) Developmental (learning disability) Acquired Dementia Severe depression Persistent anxiety Alcohol etc. Reliance on others for physical reasons
Decision Making: Mental Capacity Mental Capacity Act 2005 – Code of Practice Assume capacity – even if unwise decision Decision - specific Information relevant Mental disorder requirement for incapacity Evidence of incapacity Understanding Registration Retention Recall – current + past relevant information Ability to weigh Judgement (coercion)
Perpetrator motives: ‘Due reward’ ‘Entitlement’ (family) ‘Loan’ e.g. debts Greed Personal gain ‘Professional fraudster’
Take home Slow burn nature Dependency on family / carers Grooming features ‘Must do what they say’ (coercion) Paradoxical loyalty to abuser Medical evidence - mental disorder & capacity Use Code of Practice (Mental Capacity Act 2005) Safeguarding, safeguarding, safeguarding