Safeguarding, personalisation, empowerment, reablement, shared decision-making, person-centred working, recovery, care planning, choice and control, dignity, risk decision-making, consent – some of the key policy terms, processes and concepts that underpin and inform health and social care practice, or endemic and infuriating jargonology, depending upon your viewpoint. Many are inexorably linked together, creating complex webs of policy and practice for professionals and other staff.
Is there anything missing from the list? I expect so, but one thing that is interesting about this list is that none of the terms have legislation built around them. Mental capacity is of course a key term that is missing and does have a legislative framework built around it, the Mental Capacity Act 2005 (MCA). And mental capacity is also a concept that underpins every single item on that list; if one understands mental capacity and can apply the good principles, processes and safeguards of the MCA then one has built the best possible foundations for health and social care services that are truly responsive to the needs and wishes of people using those services.
A growing body of research indicates that where practitioners understand the MCA (even the Deprivation of Liberty Safeguards) – and it’s generally not a difficult or intimidating law to understand – it’s seen as helpful, empowering and beneficial to practice. The research we did with Bristol and Bradford universities into best interests decision-making certainly supports this.
Why then is there also evidence that the MCA is poorly understood, or even ignored? For any practitioner who wants to show respect to patients, service users or clients the MCA is a pretty good starting point. And if you value your own ability to make decisions then the MCA is potentially there to empower and protect you, should you develop an illness or condition which affects that ability.
There is a House of Lords Select Committee currently reviewing the MCA. Like many other witnesses, our evidence emphasised the importance of raising awareness and improving understanding of the MCA, not changing it, at least for the foreseeable future. Good laws should support good practice so for those of you who know about it, promote it among colleagues, and those who don’t, wise up!
Head of Development & later Life
Mental Health Foundation