Best Interests decision-making processes in learning disability services in Northern Ireland

Decision-making is part of our daily lives. However, for those who lack mental capacity to make specific decisions, such as where to live, the decision-making process may require others to make the decision in their Best Interests. The aim of this research study was to explore how decisions were made for individuals with a learning disability when they lacked the mental capacity to make a specific decision. The research focused on those whose decision-making may be impaired and so has not excluded people if they lack the capacity to understand the research. Instead, facilitated by the partial implementation of the Mental Capacity Act (NI) 2016, and underpinned by ethical approval and procedural safeguards, those individuals with a learning disability who did not have capacity to understand this study, were recruited and permitted to participate. Using a mixed methods approach the results demonstrate the value of including the voices of individuals with a learning disability who have had direct experience of Best Interests decisions. Furthermore, including professionals highlighted their perspectives of the Best Interests decision-making process. The findings reinforce the importance of involving the individual and their carers / supporters throughout the decision-making process including making them aware of the options available and how the individual's preferences are captured. The research suggests the need for a regionally agreed approach to Best Interests decision-making processes in Northern Ireland. A three-stage model to support decision-making has been developed by the research team and is currently being piloted by the Department of Health in Northern Ireland. Further research is required to explore the experiences of carers / supporters of individuals who are subject to Best Interests decisions.