So, the 15th March sees a brand new day hit the diaries of social workers, social care and health staff across the land. The 15th marks the first Mental Capacity Act (MCA) call to action day and the very first attempt by social workers and others to build a great wall of unwise decisions nationally. You can find the details of how to get involved in #unwisedecision here but get involved you really should. It will be fun and revealing, thoughtful yet light-hearted but most importantly vital to how you think about people.
In November last year I had the pleasure of working with social workers, OTs and other social care colleagues to build a Great Wall of Unwise Decisions. My colleagues then, as they always do, came up with the goods and filed our wall of unwise decisions. Even eminent principal social workers that had travelled hundreds of miles honoured us with an unwise decision.
Soon the wall was full of many many unwise decisions ranging from a fondness of real ale through to re-marrying someone who the individual had already divorced once. Skiing, spending too much money on material things, leaving assignments to the last minute and leaving a back door unlocked for 18 years all appeared amongst many other unwise decisions. The wall was fun, it provoked thinking and most importantly conversation about the equality of unwise decision making.
The ability to make an unwise decision has to be considered in the context of your right to make such a decision. But we all have that right you may say, the fact that the PSW network are running such a campaign would suggest that we don’t.
For many the MCA is seen as a positive piece of legislation, based in human rights, best interest (of the individual not others) and real lives. I would generally agree despite the lack of ability to challenge and appeal decisions easily. However, no matter how well constructed the law, it is essentially useless if not delivered and implemented in the way in which it was intended.
And here lay an intrinsically perverse and twisted problem. The discriminatory application of law alongside professionally subjective ideas of duty of care and risk management. All of the unwise decisions listed above as well as all the others written on our wall that day had one thing in common. No one batted and eyelid that others had made such decisions. Yet does that laid back acceptance or even glorification of unwise decision making get extended to people who may rely on health and social care for support to live a good and independent life? I’m not convinced.
The very things that we share and celebrate today are the very things that we hold dear, learn from, enjoy, cause us sorrow and make us cry. All things that make up a real life for the vast majority of us. Yet when others who we see as “service users and patents” make such choices strange things can happen. Moral judgements or professional fear can appear in the mind, the mantra of duty of care can be heard and the drums of control can beat a heavy rhythm. That unwise decision may now be the one thing that removes everyone else’s perception of your capacity.
This may sound harsh but it is a reality for so many and a conversation I hear all across the country in forums, from people and services alike. Lets take one of those unwise decision above. “I’ve left my back door open for 18 years”. Now apply that unwise decision to an 85 year old women who may have the onset of dementia and living alone. For many this changes things, this kick starts the risk control, the presumption that the dementia is worst than we thought and the reality that maybe just maybe our 85 year old vulnerable lady may lack capacity to protect herself. As much as we tell her how risky this is she keeps leaving the door unlocked or….. maybe she is forgetting to lock the door. Right that’s it, capacity assessment, I think it is time to consider a care environment.
Very often in such scenarios professionals forget to ask the simple questions, have you always left your door unlocked? has it ever caused you a problem?.
In a cruel twist of fate there is also an issue at the other end of the scale. The unwise decision that means social care and health will not see past it, you’re to blame for your own situation. You make such silly decision that we will not provide you with support or care that you may actually be entitled to. Again such subjective professional thinking can only bring about a discriminatory applications of, not just the act, but the right to support in our most desperate of moments.
This can often be the case in situations such as domestic abuse.The woman who faces the horror of domestic abuse yet also has health, care and support needs may often find moral judgements standing in the way of accessing quality care. interestingly at such points statements that people are making unwise decisions because they won’t leave the abuser are justifications to not provide support advise or even intervention. Disabled women are twice as likely to experience gender- based violence than non-disabled women, yet are less likely to seek help. When they do the state and its implementors often sees an unwise decision that justifies no action.
You see it’s an incredibly complex, yet incredibly simple thing this unwise decision business. Do it properly and you can work alongside people, enabling freedoms and support at the same time. Get it wrong and you run the risk of controlling people, or providing nothing at all to those who may find it hard (and personally dangerous) to come to you in the first place.
Surely that’s why we do what we do. Why we train to understand law. Why we hold dear the values that drive a profession such as social work. It is not acceptable to churn out risk averse, independence stifling capacity assessment because people do things that you think they shouldn’t or make a best interest decision based on such concepts or just because it’s the path of least resistance.
The irony is that if you are doing this properly and the person does lack capacity yet has always made this same unwise decision then your best interest decisions may well be an unwise one. If you don’t think this is ever a possibility then you may need to go and reflect on the MCA again.
On this day we are also celebrating world social work day, the theme this year;
‘Promoting the Dignity and Worth of Peoples’
It couldn’t have worked out better. So when you are writing your #unwisedecision just remember if all of the people you support made this decision how would you respond, what would you do and would there be equality on your practice.
Principle 3 is one of the clearest of all the principles set out in the MCA. Use it professionally and appropriately to uphold people’s rights to a real life not to justify yours or other professionals thinking.
I’m look forward to seeing a nations unwise decisions
For more info on this day and some great (better than mine) blogs follow the links below.