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Alcohol use or brain injury?

VOICES case study 6

*Name has been changed to protect the identity of customer


Mark* has a long history of substance misuse, homelessness, mental health and offending. He suffered a cardiac arrest and was in a coma for several months through misusing Mamba. Sadly, the long-term damage from the cardiac arrest was Hypoxic Brain Trauma due to lack of oxygen to the brain. Mark remained in hospital in the Mental Health Unit for rehabilitation due to struggles with his speech and mobility. From here he was discharged to a local hostel as social care deemed him to not have acute housing needs. At this point, Mark still had limited mobility as well as poor mental health in relation to the brain injury.


A local hostel referred Mark to VOICES due to struggling with his care needs and difficulties in managing his behaviour. They had referred him to Social Care but again had not succeeded. When VOICES assessed Mark, it became clear that he had care and support needs and therefore qualified for Social Care input. His Service Coordinator again referred the case to Social Care and with much hesitation, they agreed to come to the hostel to assess.


During the assessment, the Social Worker focused mainly on Mark’s substance misuse rather than his care needs and refused to continue with the assessment until Mark addresses his alcohol use by engaging with alcohol support services. Mark did not want to engage with alcohol services as he didn’t see his alcohol use as problematic.


Although VOICES recognised that Mark was dependant on alcohol, it was clearer to us that the alcohol wasn’t the reason for Mark’s behaviour and inability to complete simple tasks. The Service Coordinator met with Mark’s Psychiatrist from his time at hospital to deepen their understanding of Mark’s condition and his behaviour before taking the case back to Social Care.  The Psychiatrist explained that due to the brain injury sustained, Mark struggles with making impulsive decisions, retaining information, temper outbursts, etc – they stated that what is seen by services as problematic behaviour through substance misuse was in fact the result of his brain injury.


Eventually, after several Multi-Agency Meetings, Social Care accepted the duty to meet Mark’s care needs and stated they would provide a care package and a Personal Assistant once Mark was housed. Later, they then said that they would only do this if Mark contributes towards the cost of his care. This then created another blockage as Mark had already said he would not agree to do this. The Service Coordinator requested that Social Care reconsider this decision and requested for them to pay for the care package regardless of Mark’s refusal to contribute.  Social Care declined to do this meaning Mark was stuck living in unsuitable hostels/night shelters/sofa surfing – he was also repeatedly in and out of hospital due to falling and sustaining injuries as a result of his brain injury.


VOICES didn’t believe that Mark’s refusal to pay towards his care costs should be a barrier in him accessing the care he was entitled to as he was still owed a duty. The Service Coordinator then requested for the Psychiatrist to send a letter to Social Care supporting VOICES views, which he did explaining in a professional context that the underlying brain injury is the driving factor in this case, as opposed to alcohol misuse, and suggesting that providing social care without the need for the person in question to contribute financially would be beneficial in providing a quality of life.


After receiving this letter, Social Care agreed to pay all costs in relation to Mark’s support needs and he was housed in supported accommodation which catered for brain injuries, substance misuse and other complex needs. Along with this accommodation he also had a full care package funded by Social Care which paid for the costs of cleaning, shopping, support with paying bills and other daily tasks.


3 years on, Social Care are Mark’s lead support and they are currently awaiting the placement of a Personal Assistant to work alongside Mark to support him with where he/they decide necessary. They have continued to advocate on his behalf and work around his sometimes-challenging behaviour and now have a good relationship with him.


The main difficulty in this case was highlighting to Social Care that where Mark was presenting as intoxicated, aggressive, loud, losses of temper, non-engagement with services – this was in fact due to his brain injury and not his alcohol use.


VOICES worked with Mark for a total of 29 months but still have occasional contact with Social Care and Mark to see how he is progressing.

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