Safeguarding adults: Mediation and family group conferences

Case study: Tony

Tony, 76, has dementia and diabetes. He lacks capacity to make most everyday decisions, including about his living arrangements. He has two daughters, Margaret and Jess. Tony lives with Jess, whose relationship with Margaret is hostile. Tony finds this distressing.

The social worker, Ed, does not think that Jess is coping well with caring for Tony. Jess has refused support with this.

Margaret told Ed that Jess has been locking Tony in his room for long periods of time.

Tony was admitted to hospital six weeks ago as a result of his diabetes being poorly managed. When he is ready to be discharged, and against Jess’s wishes, arrangements are made to transfer Tony to a nursing home for appropriate care and treatment. He is assessed and placed under a standard Deprivation of Liberty Safeguards (DoLS) authorisation for a period of six months. The best interests assessor is Amrit.

Jess is furious and assumes this is collusion between Margaret and social services. She makes a complaint. Jess is adamant her father does not lack capacity and is now refusing to talk to Ed and the manager of the home, Janice. Jess threatens legal action to challenge the authorisation under section 21A MCA 2005 and this further strains relationships, particularly between Jess and Margaret.

Mike, Ed’s team leader wishes to refer the case to mediation because he thinks it will help to resolve the situation.

The referral

Mike explains the process of mediation to Jess and Margaret and the purpose in this case - working better together in the future to make decisions about Tony’s care. Jess and Margaret agree to take part.

Preparing for mediation: the pre-mediation meetings

It is decided that Ed, Janice and Amrit will join the mediation process.

The mediator, Erika, visits Tony, Jess, Margaret, Ed, Janice and Amrit separately and speaks with staff in the care home. Erika is satisfied that Tony does not have the capacity to participate in mediation but ensures that his wishes and feelings are central to the mediation process.

Erika ensures that everyone understands what mediation means for them and agrees to participate.

She considers everyone’s safety and whether anyone needs an advocate.

Erika asks everyone to sign a mediation agreement.

The mediation session

Stage 1: establishing the arena

Erika establishes the ground rules of mediation, and ensures that everyone agrees

Stage 2: defining and clarifying issues

Erika invites each person to share their views and the outcomes they want to see.

Stage 3: agenda setting, prioritising and planning

Erika decides that everyone should remain together in the joint session. She is aware that Jess might feel isolated and works hard to include her in the process.

Erika encourages everyone to work together to produce a list of issues. Erika plans the structure of the session and prioritises issues.

Stages 4 and 5: discussing the issues and generating options

Erika manages imbalances of power, addresses signs of vulnerability, draws out themes, identifies consensus on issues, captures possible solutions. She tries to identify middle ground, and ensures that Tony’s wishes are fully represented in all of the discussions.

Erika encourages everyone to explore options to settle their differences and to test the achievability of these.

It becomes evident that Jess, has not been coping well at home but did not feel able to admit this for fear of losing her father. Jess accepts that, while Ed’s intentions are good, she all too often interpreted this as interfering, which is why she refused support.

Margaret accepts that her relationship with Jess is at the lowest it has been and she wants to improve this for the sake of their father. For the first time in a while, Jess and Margaret talk openly about their fears and aspirations for their father and Jess’s hope that he would return home soon.

Ed and Janice are clear that the current DoLS authorisation enables Tony’s needs to be met and discuss the kind of support that would need to be put in place to allow Tony to spend some time at home. Jess accepts this and explains that she and Margaret want to remain involved in discussions about their father’s care.

Stages 6 and 7: solutions and securing agreement

Everyone is working together with more confidence. Erica checks that the solutions being generated can work, are likely to be accepted outside mediation and meet all of the concerns raised.

Stage 8: The mediation agreement

Erika prepares a written agreement, checks accuracy with the group and everyone signs it.

Stage 9: Follow-up and review

A review meeting is arranged to take place in three months’ time. This provides everyone with an opportunity to check that the agreement is working and make adjustments to it to reflect any change in circumstances.