1. Mental vulnerability & risk
Dr Peter Jefferys
Consultant Psychiatrist Norfolk & Suffolk NHS FT
CenTSA Conference 27 Sep 2016

2. Desired outcomes: Improved understanding of:
Nature of trust
Victims & mental vulnerability
Who
Why
How
Perpetrators

3. 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

4. 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

5. 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)

6. 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

7. 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

8. 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

9. 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)

10. Perpetrator motives: ‘Due reward’ ‘Entitlement’ (family)
‘Loan’ e.g. debts
Greed
Personal gain
‘Professional fraudster’

11. 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