I think the second principle is the most important because we've let it slip through the net.
It has become this orphan left behind on its own really
and mostly I think that's because we have paraphrased it as supported decision making.
It says much more than that.
It says don't actually treat that person as unable to make a decision unless you're certain
that you have taken all practicable steps to help them make that decision
and that those steps weren't successful.
There's loads there
and it does it a disservice to shorten it to something about support.
So any practitioner you ask in a room, I open training and I ask them:
what are those practicable steps?
They say: well I'll make sure the person can hear me,
that they can see, that I'm speaking to them clearly,
that it's the best time of day for them,
that they're most alert ... Yes, those things are really important
but that's not it. That's about how you're facilitating communication with that person.
Really, really important, but that's not going to help them make a decision.
I guarantee you that if you ask this of a practitioner
when they're thinking about practicable steps
they're thinking about getting through a capacity assessment.
They've merged the two together and they need to be separated out.
The practicable steps are to help the person make the decision.
And when you are certain that there are no practicable steps left that you can try
because they've all been unsuccessful then you move on to your capacity assessment.
That puts a real responsibility on us as professionals working with people who might have a mental impairment.
So what are the steps? What's going to help them make the decision?
Not what's going to help them understand me or not what's going to help them take part in this assessment,
what's going to help them make the decision? And that'll be different for everybody.
So you need to know an awful lot about that person, how they make decisions,
what their strengths are, how long they need to be given
and a whole range of information before you can say, right, OK, I've done that without success.
How do we make decisions? Do we all do that in the same way?
You know, do we talk it through with other people? I would,
I wouldn't just make a decision on my own.
You know, we need those different people in our lives to provide support in different ways.
Sometimes you just need to think it over.
You know, I think it's very rare that you find in a social care setting
saying to somebody this is the decision, I'm going to share information with you about that,
go away and think it over. Sleep on it, talk to your friends.
You know, let's find an expert. Let's get someone in who's an expert in this field
and let's go and talk to them.
We are sort of not thinking like that, where the person's got a cognitive impairment.
The kind of work that I'm doing with our social workers is saying to them OK,
you know, this is the decision, the issue or the action needed,
is there a programme you could put into place
in order to work towards the person being able to make that decision?
The trouble is, it's going to take time.
And I know practitioners are short on time and they'll say to me, Lorraine, you know we haven't got that time.
But the culture change is, spend the time now, front load it, if you like,
and you will need less time further on.
Because you won't be involved in best interest meetings and sitting around a table with a bunch of ten professionals,
you will have achieved this kind of level of empowerment where the person can make his own decision
from small to big.
So it's really, whatever the decision, you need to know the person,
you need to know their strengths and you need to use their strengths to help them make the decision.