I’ve been thinking a lot about what works well, and what perhaps doesn’t work so well, when social care professionals try to empower people who might lack mental capacity to make their own decisions. And this is closely linked to how these professionals do make these decisions, if someone can’t decide for him or herself.
No decision about me without me!
This is one of the rallying-cries of people with learning disabilities, when they are trying desperately hard to achieve as much independence as they can. This message is at the heart of the Mental Capacity Act (MCA) as well – hence, it is at the centre of lawful practice. Unnecessary risk aversion or paternalism in the way we intervene in the lives of others is not only harmful to them, and limits their potential, it is against the law.
The first three principles of the MCA make it clear that people must be supported and empowered – by all steps that can be thought of – to make their own decisions. Also, that nobody can be assessed as unable to make a decision just because they make one that others consider unwise.
Short pause for reflection
Take a moment to recall some ‘unwise decision’ of your own. All of us have done things that we ourselves, with hindsight, consider to have been incredibly foolish. That’s how we learn and grow.
The ‘empowering ethos’ of the MCA
I’ve just been re-reading parts of the House of Lords MCA committee’s report on how well (or badly) the MCA was being implemented. It’s a great read, but the picture isn’t entirely rosy. It has been hard for the ‘empowering ethos’ of the MCA to make inroads into a health and social care culture that can be overly risk-averse (‘I don’t want anything to happen when I’m on duty’) and paternalistic (‘and anyway staff know best’).
It’s good to hear what it feels like, though, for people who are at the receiving end of services. They certainly welcome the ‘empowering ethos.’
I feel grateful to the people connected with Mencap Hammersmith and Fulham branch, who helped the House of Lords MCA committee to report on how well or badly the MCA has been implemented. They gave some useful pointers:
What do we like?
- I am included in making decisions.
- I get to choose what I want to do.
- My sister helps me.
- I like having help with my money.
- Have friends involved.
What could have been done better?
- Talk to me first about it.
- Make sure family don’t overrule me.
- Check after decisions are made that I still feel the same way.
These pointers are not difficult; they won’t cost more than thoughtless paternalism; and they so clearly reflect what we’d want for ourselves in that situation. As a way of thinking, it takes a lot of beating.
