The impact of the Mental Capacity Act

A younger woman with a concerned expression listens to an older woman speak

Today is National Mental Capacity Action Day. The action day was designed to raise awareness of mental capacity and prompts us to consider the impact that the Mental Capacity Act has for the lives of the people who use health and social care services.

The Mental Capacity Act sets out that everyone has the right to make their own decisions. This is fundamental to promoting choice, control, independence and well-being. It is the role of health and social care professionals to enable people to make decisions and to provide support to maximise their capacity to make those decisions for themselves.

It’s particularly relevant for Sense, and the work we do, that the theme of this year’s action day is supported decision making – which is about providing information to people, and the practical steps required to support the them to make and communicate their decision. This is a powerful aspect of mental capacity practice. For health and social care professionals, this should always be the starting point, rather than focus on what should happen when a person is unable to make the decision for themselves.

A person centred approach

At Sense, our expertise and experience of supporting understanding, making connections and working in a person centred way to unlock barriers to communication means that supported decision making is always at the heart of our approach. We work with people to find ways to empower them to communicate and express themselves – be it through speech or sign, touch or movement, gesture or sound, art of dance. People’s communication style is unique to them and is often reliant upon the people who know and understand them well to be able to recognise and respond.

Emma is a young person who attends the Sense College. She uses sounds and gestures to communicate her decisions, choices, preferences and feelings. We have developed communication tools to be able to understand and respond and to provide a consistent approach to communication with Emma. This has helped us to build our understanding of what is important to Emma and we know that she likes to spend time with her family, friends and the team at the college.

With the right support, Emma can make decisions about many aspects of her daily life, including how she spends her time and day to day choices about the clothes she likes to wear. She also likes to cook and prepare food for other people – this has proven to be a very powerful way of engaging with Emma and through the use of visual supports and her communication tools, she is able to make decisions about what she wants to prepare. She has developed some extremely positive relationships and connections with others through her love of food and has gained confidence and skills as a result.

For other decisions that Emma does not have the capacity to make, we follow a Best Interest process to ensure the best possible decision is made on her behalf. We have developed a decision making agreement to be clear about the decisions that Emma makes for herself, as well as any decisions made in her best interests. We review this on a regular basis as Emma is gaining skills, confidence, experience and understanding all of the time and which will influence her capacity to make other decisions in her life. The decision making agreement provides clear guidance to everyone involved in Emma’s life to make sure we offer the right support to her to be in control and make choices and decisions.

Supporting people to be in control of their own lives and to be at the centre of decision making is key to the work we do in health and social care. It can be challenging, particularly when there are conflicting views about what is in a person’s best interests; or where a decision can have life changing implications for the person; or indeed, where a person is seen to making unwise decisions. The Mental Capacity Act has provided a powerful framework to navigate some of these challenges and offers safeguards to protect the person’s choice, control and freedoms. However, our experience shows that it is through effective communication, understanding and relationships that really enable people to be supported to make decisions.

At Sense, we will be using the National Mental Capacity Action Day to recognise and celebrate outstanding practice in relation to supported decision making.

Sense provides housing options and individual support services for people with complex communication needs, to allow people with complex communication needs to be as independent as possible.

Author: Jonathan Monk

Jonathan is the Head of Quality at Sense

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