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Investigation into the care and treatment of AB

Publication date: 3 Aug, 2023

The Mental Welfare Commission today published an investigation report into the care and treatment of AB, a vulnerable person with learning disabilities and physical ill health, who died in hospital after being under the influence of another individual for many years and despite multi-agency concerns about the impact of this influence.

The investigation is anonymised, as all Mental Welfare Commission investigations are. 

The report illustrates the importance for health and care professionals of fully assessing an individual’s capacity for decision-making; balancing human rights and considering the potential for undue influence.

Concerns had been raised by AB’s family, by social work and health services and by others, leading to AB being subject to three Adult Support and Protection investigations and two periods of detention in hospital under the Mental Health Act in the five years leading up to their death.

Despite this, actions which could have been pivotal in ensuring there were statutory protections in place for AB and which could have helped their access to and provision of medical treatment  were not taken. Instead, AB remained under the influence of the individual throughout and access to needed treatments was impeded up to the time of their death.

The Mental Welfare Commission makes six recommendations for change jointly to the NHS health board and local authority involved in this case, and one recommendation to Scottish Government.

Suzanne McGuinness, executive director (social work), Mental Welfare Commission, said: 

"This is a very distressing case, where a vulnerable person was isolated from their family by another individual over many years, to their personal detriment. It resulted in increased poor health and an early death. Despite opportunities, no effective intervention which would have changed AB’s circumstances was made.

"Our recommendations for change cover social work and health care, but they also address the issue of legal authority and power of attorney, recognising that someone who may lack capacity for decision making about their health or welfare needs may be under the undue influence of another person.

"It is vital that this report is shared, read and discussed in detail by social work, mental health and general health services across Scotland, and by legal services. We believe there are lessons to be learned across the country and we hope this in-depth report will help raise awareness of the importance of identifying where undue influence may exist and the legislative frameworks which can be used to avoid similar situations in future.”

This report is one of a series of investigations carried out by the Mental Welfare Commission as part of Commission proposals to review how deaths of people detained for mental health care and treatment are reviewed across Scotland. Further information can be found here.