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Is There Nothing We Can Do?
One of the issues that crops up for staff is, where they are caring for people who have the capacity to make decisions about their own care needs, how can they staff ensure they are providing good care for a service user if the person says no to the kind of help and support that is being offered. Put another way, have you heard people say, “There's nothing we can do – they've got the mental capacity to refuse care”?
Causes for concern
Let's examine this a bit more with a case example I've used from training materials developed by the Social Care Institute for Excellence on the topic of safeguarding. The scenario begins: ‘Mary is 27. She has a moderate learning disability and lives with her older brother, John, and his wife, Pauline. She attends a day centre.’ The scenario goes onto describe how staff notice that Mary has been arriving in dirty clothes, and then discover bruises on her arms which she tries to hide.
The question I pose is that if Mary says she doesn’t want the care staff investigating the causes of these bruises, possibly because she doesn’t want to jeopardise her relationship with Pauline, does that mean the care worker can't do anything to help Mary, if she believes Mary has the capacity to make decisions around her care and well-being, and where and who she lives with?
Duty of care
Briefly the answer is ‘no’ – there are a number of things that can and should be done. Firstly remember that the care staff have responsibilities to ensure Mary is protected. Mary may have capacity but she is a vulnerable adult and the day centre has a duty of care toward her (and policies to meet those duties). The concerns here may trigger a safeguarding investigation. There might be reasonable explanations as to why Mary has bruises, but we need to find out. The decision to share information and concerns with others is one for the day centre staff, not Mary. The day centre will have a confidentiality policy that will provide a framework as to who they will share this sensitive information with. A referral to the local safeguarding authority would be the first step.
Ultimately, Mary will have capacity to decide whether she wants to live with Pauline and John, but we are long way off having to make that decision. Let's see first what safeguarding inquiries produce. It may be that the police are involved if there is suspicion of crime. Or it may be that Pauline needs some help and support herself in looking after Mary, and other agencies might offer that.
Mental capacity legislation is a useful tool for protecting adults who lack mental capacity to make certain decisions. For those who do have capacity, we've got some other considerations to make.
David Beckingham – QCS Expert Mental Health " href="http://www.ukqcs.co.uk/cqc/mental-health/" target="_new" data-tooltip="According to statistics produced by the Mental Health Foundation, 1 in 4 people will suffer from a mental health issue at some point in their life. For care providers, this means being aware that mental health issues require specialist skills in handling and that they can come on at any point in life. Depression in particular must be looked out for by care professionals, as it affects 1 in 5 older people.<br /><br />Mental health problems range from mixed anxiety and depression to bipolar disorder and feelings of suicide. Mental health isn’t just about dealing with service users who have specific problems, but ensuring that all service users remain mentally healthy. Good care will look towards enabling service users to make the most of their life and their potential, to remain active and stimulated and to play a full role in their community, in their family and in their treatment.<br /><br />There are now specialist care homes and domiciliary care agencies which specialise in the care of people with mental health problems, doing their best to eliminate the stigma and to offer those in its care respect and dignity at all times.">Mental Health Contributor