Understanding mental capacity
Understanding mental capacity

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Understanding mental capacity

1.2 How do we make decisions?

It is easy to take our ability to make a decision for granted, but a number of factors underlie it: information, confidence, experience and the knowledge of likely consequences of different courses of action.

In the video below, a man with learning disabilities discusses how he makes decisions about money with a social worker. Their discussion illustrates how someone in these circumstances can be supported to manage their own money.

Download this video clip.Video player: mhc_1_week2_vid1.mp4
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Transcript

[MUSIC PLAYING]
NARRATOR
In this film we meet Roger, a man with learning disabilities living in supported housing. Roger has recently moved with the help of Tracey a social worker, and does not have an appointee to look after his benefits. Tracey is concerned that the staff at Roger's home may be crossing a line between supporting Roger to decide how he spends his money and making some financial decisions for him. Tracey is meeting Roger to assess his capacity to make decisions about his money.
One outcome could be to apply for an appointee. At the same time, Tracey is trying to find out if Roger would like more help to make his own financial decisions. Roger and Tracy role play this situation. Extracts are shown of what would be a longer process.
TRACEY
The reason I've come to talk with you today is to have a chat about what you understand about your money, the money that you have coming into you, the money that is spent and to have a discussion about how you do that and how people help you with that. OK?
ROGER
Yeah.
TRACEY
And to see if there's any ways that we can improve how that works.
ROGER
Yeah.
TRACEY
OK. So I won't be writing very much, but sometimes I might need to do that so that I don't forget things.
ROGER
Yeah.
TRACEY
OK. First of all, can you just tell me a little bit about who in the house helps you with things around money?
ROGER
Miss-- the support workers, they ca-- they-- they help me with my money.
TRACEY
Can you think of some of the things that they help you with?
ROGER
They help me sometimes with my budgeting. Yeah.
TRACEY
What does that mean? How do they help you with that?
ROGER
Well, sometimes I have to go to the Building Society to-- it's in town-- to-- if I want something, I have to-- if it's not much...
TRACEY
And the support workers come with you then?
ROGER
Yeah. They go with me.
TRACEY
And when you get there, what do you have to do? Do you have to pay for anything when you get to the bank?
ROGER
I have a bank book. I get help with the counter.
TRACEY
So you take your bank book. Is that to--
ROGER
To get the money out.
TRACEY
To take money out. OK. So the support worker comes with you to the Building Society and you take your bank book.
ROGER
Yeah.
TRACEY
And take some money out. Who decides how much money to take out?
ROGER
Before we set on a journey, or-- I ask before how much-- how much money to get out.
TRACEY
So can you tell me the kind of things that you need to use that money for? What do you spend it on?
ROGER
Some of the money I have to use for food con-- food contribu--
TRACEY
Food contribution?
ROGER
Yeah. I have to pay rent, and I get money for if I go anywhere out important to different places.
TRACEY
You do quite a lot of different activities, don't you?
ROGER
I do, yes.
TRACEY
So do you need a bit of money for each of those activities?
ROGER
Starts in my house has a lot me to... too-- have some money on me. Yeah. For different things.
TRACEY
OK.
ROGER
Yeah.
TRACEY
I know that you're very interested in going out on your own.
ROGER
Yes.
TRACEY
And you do that quite often.
ROGER
Yeah.
TRACEY
Yeah? OK. So I want to ask you about how much money you take if you went out on your own. For example, if you went out to go and have some lunch, is that something you do? Isn't it?
ROGER
Yeah.
TRACEY
So if you were going out to have some lunch without a support worker, do you know how much money you might take with you?
ROGER
Sometimes I take 4 pound If I don't have 4 pounds in my tin, they let me have 10 pounds for lunch,
TRACEY
OK. So what would be one of your favourite lunches? What do you like to have when you go to your cafe?
ROGER
I like to-- I know it's not very healthy, but I do like fish and chips.
TRACEY
Do you? OK.
ROGER
Yeah.
TRACEY
Do you have a drink when you have your fish and chips?
ROGER
Yeah. Yeah. With me I like a hot drink. I love tea or if they don't serve tea, I ask could I have a cup of coffee.
TRACEY
OK. So you like to have a hot drink with you.
ROGER
Yeah.
TRACEY
OK. If you had fish and chips and a tea, could you guess how much that might cost?
ROGER
Some of the cafes are a dear.
TRACEY
Some are dear and some are not so dear. So would it be-- what would a dear one be I wonder? If you had to pay 5 pounds for your fish and chips and tea, would that be dear or not dear?
ROGER
No. I don't mind.
TRACEY
You don't mind that, 5 pounds.
ROGER
No.
TRACEY
That seems quite reasonable, doesn't it?
ROGER
Yeah.
TRACEY
Fish and chips and a tea.
ROGER
Yeah.
TRACEY
Have you got-- you told me earlier about each day you have your money, your support worker helps you to puts it in your money bag.
ROGER
Yeah.
TRACEY
You've got that with you?
ROGER
Yeah.
TRACEY
Would you mind getting it out and showing me what you've got there?
ROGER
I'll put this down.
TRACEY
Excellent. Right. So let's have a look. Can you open it up?
ROGER
I can open it.
TRACEY
Right. So what's that note there you've got?
ROGER
I have 5 pounds now.
TRACY
You've got a 5. OK. 5. And what else have you got there? Can you count it out for me? Are you able to?
ROGER
That's 5 pounds. 6.
TRACEY
6.
ROGER
7.
TRACEY
7.
ROGER
7.50
TRACEY
7. 50. Excellent.
ROGER
Yeah.
TRACEY
OK. So that would be enough then--
ROGER
For--
TRACEY
So if you spent a 5 for your fish and chips and your tea, what have you got left there?
ROGER
2 pounds 50.
TRACEY
2.50. So say you you've been out for your lunch and then you're on your way home, and you fancied something from the shop. Do you ever pick up anything from the shop on the way home?
ROGER
Buy a Mars sometimes.
TRACEY
A Mars?
ROGER
A Mars bar.
TRACEY
Yeah? How much is a Mars bar these days?
ROGER
Oh, it's 50 or 60.
TRACEY
Is it? Would you like to have the chance to take more out with you in case you might see something that you fancied like a-- I don't know-- something a bit bigger?
ROGER
Yeah.
TRACEY
Do you ever go clothes shopping?
ROGER
Clothes shopping. Yeah. I go with him Mister.
TRACEY
You do. OK. That's something you do with them. All right then. Well, maybe that's something that we can talk to the support staff about.
ROGER
Yeah.
TRACEY
Because you do seem to be-- I'm sure you're quite careful with your money when you go out.
ROGER
Yes.
TRACEY
And you seem to know how much you need to spend and how much you've got in your bag there. OK. Well, that's been really helpful talking about that, Roger. Do you ever get to see the information about what's going in your bank account or the Building Society account? It's called your statement. Do ever see those?
ROGER
I get shown where that is.
TRACEY
OK. So you look at that?
ROGER
I look at that.
TRACEY
OK. So it sounds like the support workers at your home--
ROGER
Yeah?
TRACEY
They're quite helpful to you?
ROGER
Yes.
TRACEY
And they're quite involved in helping you to make decisions about getting your money from the Building Society and helping you to decide what you need to do.
ROGER
Yeah.
TRACEY
How much you're going to need each day when you go out.
ROGER
Yeah.
TRACEY
Yeah. Is there some ways that the support workers could help you to make even more decisions about how to use your money?
ROGER
Yeah. Yeah.
TRACEY
I wonder what might be helpful to you.
ROGER
Yeah.
TRACEY
Do you feel that you can-- if-- for example, if you wanted to spend something-- go and buy, I don't know. You like listening to music, don't you? Do you ever go and buy music?
ROGER
I do. I do.
TRACEY
So if you wanted to go and buy some music, or even if you wanted to buy something bigger like something to listen to your music on, would you feel able to make a decision on that?
ROGER
I would have to talk it through first.
TRACEY
OK. So it sounds like the support workers help you quite a lot.
ROGER
Yeah.
TRACEY
Yes.
ROGER
Yeah. Yeah.
TRACEY
And is that something that you're happy with?
ROGER
Yes Yeah. I wouldn't know where the money was going to.
TRACEY
OK OK. Is there anything that you'd like to learn to do with your money or anything you'd like to learn about managing your money that you don't do now?
ROGER
[INAUDIBLE] to know sometimes where with the money going to.
TRACEY
That these are the things that-- the ways in which your money is being spent that you don't usually see.
ROGER
No.
TRACEY
OK. Would this be things like how much is going on the rent and bills and things like that?
TRACEY
Yeah.
TRACEY
OK. So maybe there's a way that we could talk with the support workers about involving you more in seeing what money's coming out of your account and what it's being spent on.
ROGER
Yeah. Yeah. Yeah.
TRACEY
OK. Well, that sounds like a really good idea.
ROGER
Yeah.
TRACEY
Because it is your money, isn't it?
ROGER
Yes.
TRACEY
Yes. All right, Roger. It's been really, really helpful having this chat with you this morning about your money and how you manage it.
ROGER
Yeah.
TRACEY
That's really good. And there's some things that we can talk to your support workers about.
ROGER
Yeah.
TRACEY
Is there anything else that you wanted to say to me?
ROGER
I do like having-- I like having money here to--
TRACEY
You like having money on you.
ROGER
Yeah. Yeah. It would be-- If I didn't-- if I didn't have any money, I'd be a bit lost.
TRACEY
Yes. Oh, good. Well, that's important. That's important for you to have your own money, be able to go out when you choose, and spend it on the things that you want to spend it on. Yeah. Good. That's really important.
ROGER
Yeah.
TRACEY
All right, Roger. Well, if there's nothing more that you want to say or tell me, then I think we've spoken enough about that today. All right. Thank you very much.
ROGER
Yeah.
End transcript
Interactive feature not available in single page view (see it in standard view).

Box 1 lists some of the factors that enable someone to make decisions for themselves. Support should be provided in all these areas to ensure that all possible steps are taken to enable the person to make decisions for themselves.

Box 1 Factors that enable decision making

  • Impartial advice: no bad influences or inappropriate pressure
  • Information from trusted sources
  • Ability to realistically appraise the options available
  • An understanding of the consequences
  • An understanding of the context
  • Appraisal of prior decision making by self and others
  • Previous experience of good and successful decision making
  • The opportunity to put a decision into action.

A person should be given all the help they can, in an encouraging environment, to make decisions for themselves before they are judged as being unable to do so. But what if they make a decision that seems eccentric or even unwise? Should someone else make the decision for them?

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