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Supported decision-making in practice

Elderly mother and daughter walking in park. Mother uses walking frame, while daughter helps support her.

Within the realm of Mental Capacity, when we talk about ‘supported decision-making’, this refers to any form of assistance given within the decision-making process. This may include the provision of relevant information, or even providing education around a topic to help someone make a choice.

Whatever amount of support is provided, it should be completely impartial and should not be leading in any way, even if we have our own personal views on whether a particular decision is a ‘good idea’.

Making decisions

Many of the decisions that we make on a day-to-day basis will be supported in one way or another, even if typically, we are able to access this support ourselves, without the input of a health or care professional. This may be because we consult with family or friends, look at leaflets and resources available to us, or we perhaps do some research online. If the decision we are making is not within our existing area of expertise, we will typically explore this area more widely, seeking advise from a relevant professional or those with personal experience. From which we are seeking to understand the topic at a basic level, including the viable options available to us, and their associated risks and benefits.

In doing so, we will then exercise some independent judgement over the specific decision. This includes the choice of whether or not to engage with the information available to us, but also in terms of the way we personally prioritise the various risks and benefits. This will often be based on our own previous experiences, plus our pre-existing beliefs, values and feelings.

In the end, we will make a decision based on applying understanding and retention of the relevant information to weighing-up viable options to make an informed choice.  

Why should we apply supported decision-making in practice?

Supported decision-making should be standard practice in our professional lives. This means helping the people we work with to access the relevant information to make decisions on their own wherever possible (whether we agree with their decision, or not).

This is an important principle as part of inclusion and accessibility legislation, as well as part of well-known practices of person-centred care. Not to mention being principle 2 of the Mental Capacity Act (2005).

Without supporting the decision-making of the people we work with, we are disempowering them, as well as de-skilling, disabling, and stripping them of their basic human rights and autonomy. In these circumstances, the provision of care without supported decision-making and inclusion, however well meaning, becomes a form of abuse.

Don’t overthink it – it’s not rocket science

The most important aspect of supported decision-making is inform, listen, and allow the individual time to process the information, and give them space to ask questions. Authentic communication is the biggest asset in this area – as it is in so many areas – and is often an undervalued tool.

This will mean giving consideration to how the individual best communicates, such as their first language, whether they use sign language, or written forms of communication, and also whether they need some form of augmentative technology to support them. As well as recognising any sensory impairments such as hearing or vision loss.

Other ways to support decision-making may include:

  • Give time and space to consider and respond, remembering we all process information at different speeds
  • Ask open questions to support reflection
  • Provide and use information leaflets
  • Provide and use easy-read leaflets, that have accessible language and images to aid understanding
  • Use objects of reference to support explanations,
  • Demonstrate or explain options with the use of pictures/videos, or physically show if applicable,
  • Work through scenarios using visual examples

We should also consider where and when these conversations are happening, and whether the environment may impact on the individual’s ability to engage.

If ever you are in doubt about any of these areas, you should feel empowered to liaise with health / care professionals to help you with accessibility and making reasonable adjustments to help the individual with their supported decision-making. This may include accessing services such as Advocacy, Speech and Language Therapists (SLT) or Occupational Therapists.

If you have any questions about any of the topics covered in this blog, or would like training and support in applying best practice to your setting, please get in touch.

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