Other classic areas of supervision

Asset management can be one of the duties of a guardian, for example if the court decides that a person does not manage his or her own money in his or her favour because of his or her underlying illness or disability. For example, a person with a bipolar disorder in the manic phase may enter into contracts that he would not otherwise have agreed to. Also in the case of depression, the lack of drive that often accompanies the illness can mean that money transfers are not made, which can also lead to financial and legal problems.

If a caregiver is therefore entrusted with a duty to provide financial security, the person being cared for is not, however, completely denied access to his or her own assets, so that he or she is not completely incapacitated. It is nevertheless still possible to buy basic things that are important for the livelihood. This applies for example to food purchases.

If it is now a question of larger purchases or luxury goods, the carer must be involved in the decision and can invalidate a purchase without consent. In this case, however, a carer is legally obliged to make a decision in the interests of the person being cared for. The main task of the supervisor is to protect the financial interests of the person being looked after.

This also includes taking care of the income from sale or rental income as well as expenses such as claims by the landlord or the bank. The term accommodation describes a measure in which a person is deprived of his or her freedom because his or her judgement is impaired due to illness and would injure himself or herself or others without the measure. In most cases, mentally ill persons are accommodated in the psychiatric ward of a hospital, but accommodation in a home or apartment is also possible.

In this case, the space in which the person being accommodated can move is severely restricted and controlled for self-protection. If the medical conditions for accommodation are no longer met, accommodation may have to be terminated prematurely. Every person who is no longer “able to give consent” and is admitted to a closed ward against his or her will is placed in forced accommodation.

This is formally, before the law, first of all a considerable violation of the patient’s rights. For this reason, only the considerable endangerment of the patient or by the patient can lead to such a compulsory measure. Except in an emergency, any forced placement must be approved in advance by the court.

In this context, an emergency is defined as e.g. acute suicide or acutely aggressive behaviour by others. In Germany, the period in which a person can be temporarily detained against his or her will until a judicial hearing has to be held varies between 24-72 hours. Similar to the initial establishment of care, a medical certificate must be obtained for each forced placement.

In principle, the caregiver is essential for placement, as it is his or her task to submit an application for placement or for the end of placement in good time. If there is no guardian yet, a temporary guardian can be appointed. If danger is imminent, immediate temporary accommodation may also be possible, but this must be reviewed by the local court as soon as possible.

In Germany, the period during which a patient can be held against his or her will without a judicial hearing varies between 24-72 hours. In principle, all kinds of examinations and therapies may only be carried out on people who have given their consent. As a prerequisite for such consent, the legislator provides that a patient must be able to see the scope of medical treatment or its refusal.

Nor can a caregiver determine compulsory treatment if the patient being cared for is able to give consent from the doctor’s point of view. Example: A patient with a chronic alcohol addiction is forcibly transferred to psychiatric care by his caregiver because of acute suicidal tendencies. During the 3-week stay on the closed ward the patient shows clear signs of cancer.

The ward doctor now recommends various diagnostic measures. The patient rejects these. Since he is already physically detoxified at this point and therefore, from a medical point of view, quite capable of giving his consent, he has the right to refuse these examinations, even if his caregiver thinks otherwise.

A complicating exception is the case that there is already care for a case or “life matter” under discussion because it has already occurred in the past. Examples of this would be intravenous medication in the context of a chronic condition such as schizophrenia, where the patient stops taking medication in the acute stage, for example, or seatbelt securing at night because a patient with dementia has fallen out of bed several times due to physical agitation and injured himself. To clarify whether a patient is able to give consent or not, non-psychiatrists should arrange for psychiatric consultations in case of doubt. However, the situation is different for emergency treatment. For example, if a patient is unconscious and is referred to a doctor for treatment, only the doctor providing the initial treatment decides on the measures to be taken.