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Barriers to supported decision-making in practice

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Evidence based practice is essential in healthcare, and indeed many other sectors.  It provides proof of impact, or outcome, through careful assessment and comparison in controlled environments. In today’s blog, we will examine a recent systematic review of the field, published in the journal Health Expectations looking particularly at the barriers to supported decision-making that the paper identifies

Supported decision-making interventions in mental healthcare

In their review, Francis, Johnson and Wilson (2024) identified 140 articles that reported an intervention for adult service users published in English between 2008 and October 2023.

They found that despite the wide range of research papers that consider supported decision making, the ‘field remains exploratory in nature’ requiring further study to validate approaches.

The authors also identified numerous barriers to supported decision-making in practice. From which they argue the need for practitioners to recognise and reflect on these barriers, in order that they may grade and adapt factors in order overcome or reduce their influence wherever possible.

Barriers to supported decision-making

Frances, Johnson and Wilson categorise barriers to supported decision-making under three headings, providing examples of each. These are:

  1. Organisational Barriers
    • Cultures that are closed to developments or alternate approaches, risk management priorities, organisation’s structure, staff shortages, resources and training.
  2. Process Barriers
    • Lack of knowledge, training and time; concerns of service users’ health status; problems with both completing and using the plan in terms of confidence, skills, following direction etc.
    • This suggests a lack of reflective practice and arguably also a lack of effective supervision.
  3. Relationship Barriers
    • Fear and distrust can impact on professional therapeutic relationships. This can include: poor engagement, practitioners resistant to change, or even a misunderstanding by professionals who have mis-held beliefs that they were already applying supported decision-making, or that it should not involve them personally.

    In our recent blog on supported decision-making in practice, we considered the basics of how supported decision-making should work. Effective support needs active reflection on the part of the practitioner in order to identify the person’s needs, and apply logic to help overcome any obstacles.

    The issue that we face so often in our line of work is that it can be all too easy for us to make automatic responses to certain situations or behaviours. These responses may be shaped by our personal life experiences, or even just learnt behaviours based on societal norms that lead us to make assumptions about the individual based on societal norms, rather than putting the person at the centre of care.

    Importance of reflective practice

    As professionals, we should all engage in an ongoing process of reflective practice through which we may take the time to consider our own position as practitioners and how our previous experiences shape the way we respond to challenges in our professional lives.

    Here at Mental Capacity Ltd, we offer a range of training packages in this area, looking specifically at reflection in practice, and how reflection can help us improve the quality of care we provide.

    We can also work with teams to develop their own easy-read frameworks for supported decision-making, plus tools for education around specific decisions, as well as other resources, and specific mentoring and coaching.

    For more information on consultancy, training or assessment, please do visit our services page or contact us.

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