This exercise will help to develop participants understanding of supported decision making and learn how this differs from substituted decision making. Instructions: Using PP slides 15 - 19 explain ‘what is supported decision making’ and how this differs from ‘substituted decision making’. Split participants into small groups of 4-6 and distribute Handout 4. Ask groups to work through identifying the advantages and disadvantages of each approach. After 10-15 mins ask groups to now consider question 3: What is the advocates role in this approach? Bring participants together in one large group to facilitate feedback. Handout 4 – with possible responses: Supported Decision Making Substituted Decision Making Q1. Advantages? Person centred Protects the autonomy of the individual Prevents other people from making decisions on behalf of a person Ensures decisions and plans reflect individual choices Provides a legal framework to make decisions on behalf of people who lack the capacity to make specific decisions Ensures decisions are made which promotes best interests Q2. Disadvantages It is very limited when a person’s choices are unclear. Could override a person’s choice if it is not in their best interests Q3. What is the advocacy To support the person to understand what is To gather information To represent
A joint assessment, where relevant agencies work together to avoid the person undergoing multiple assessments (including assessments in a prison, where local authorities may need to put particular emphasis on cross-agency cooperation and sharing of expertise). A combined assessment, where an adult’s assessment is combined with a carer’s assessment and/or an assessment relating to a child so that interrelated needs are properly captured and the process is as efficient as possible. Table to consider Eligible Needs Needs Outcomes Wellbeing The needs arise from or are related to a physical or mental impairment or illness. As a result of the the adult is unable to achieve two or more of the following: a) managing and maintaining nutrition; b) maintaining personal hygiene; c) managing toilet needs; d) being appropriately clothed; e) maintaining a habitable home environment; f) being able to make use of the home safely; g) developing and maintaining family or personal relationships; h) accessing and engaging in work, training, education or volunteering; i) making use of necessary facilities or services in the local community including public transport and As a consequence, is or is likely to be a significant impact on the adult’s wellbeing, including the following: a) personal dignity (including treatment of the individual with respect); b) physical and mental health and emotional wellbeing; c) protection from and neglect; d) control by the individual over life (including over care and support provided and the way it is provided); e) participation in work, education, training or recreation; f) social and economic wellbeing; g) domestic, family and personal relationships; day
recreational facilities or services; j) carrying out any caring responsibilities the adult has for a child. h) suitability of living accommodation; i) the individual’s contribution to society. Which assessment is most suitable? Person Type of Assessment Why Advocacy role within assessment processes Before:
Advantages Disadvantages Person receiving advocacy does not have to retell their story to repeated people Difficult to develop specialist expertise Reduces the number of people involved in a person’s life Unrealistic expectation for advocates to hold technical knowledge of Mental Health, Mental Capacity and Children’s legislation Cost effective Specialist local services embedded in community provision could lose out Joined up and seemless Service users from seldom heard groups at risk of not receiving specialist support Split participants into small groups to work through case study Theo Guidance for feedback: Q. Is Theo eligible to receive support from an Independent Mental Health Advocate (IMHA)? Only for the duration of his detention (or if he is moved to a Community Treatment Order). An IMHA could support Theo understand his rights under the Mental Health Act and understand the care and treatment he is receiving. Q. Would an Independent Mental Capacity Advocate be instructed to work with Theo?