Key components of supporting and assessing decision making ability

Paul Webb, Gavin Davidson, Rosalie Edge, David Falls, Fionnuala Keenan, Berni Kelly, Aisling McLaughlin, Lorna Montgomery, Christine Mulvenna, Barbara Norris, Aine Owens, Rebecca Shea Irvine

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Abstract

People's ability to make decisions may be impaired for a wide range of reasons, including by mental health problems and learning disabilities. Individual autonomy, the ability to make decisions about our own lives, is a fundamental tenet of democratic societies. This has been reinforced by laws governing substitute and supported decision making and most significantly by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Article 12 of the UNCRPD requires everyone to have equal recognition before the law and, to achieve this, the necessary support and safeguards must be available. There has been considerable debate about the important theoretical and philosophical issues involved and growing research about the practice complexities of supporting and assessing decision making ability or mental capacity. This article aims to present some of the key components of the support and assessment process to inform further service development and training in this area. The key components were identified as part of a qualitative, participatory research project which explored the decision making experiences of people with mental health problems and/or learning disabilities. The conventional approach to the assessment of capacity is to consider four main components, whether the person is able to: understand, retain, use and weigh, and communicate the information needed to make the decision at that time. The findings from this research study suggest that people generally don't usually talk about their experiences of decision making in terms of these four components and approaches to supporting people to make decisions don't necessarily break the support down to explicitly address the assessment process. However, considering support for all aspects of the functional test may be helpful to ensure it is as comprehensive as possible. The challenges involved in providing effective support and assessing decision making ability are discussed and the article concludes with some of the implications for training, service development and practice.
Original languageEnglish
Number of pages46
JournalInternational Journal of Law and Psychiatry
Volume72
Early online date27 Jul 2020
DOIs
Publication statusPublished - 01 Sep 2020

Keywords

  • Mental capacity; mental health; intellectual disabilities; learning disabilities; UNCRPD; assessment; training

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