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Straight From The Gut

December 14, 2012

Lucy Series wrote another wonderful piece yesterday on mental capacity and making decisions. It might seem that I’m forever latching on to her ideas but I do find her writing so inspirational. For the whole post, see here (http://thesmallplaces.blogspot.co.uk/2012/12/thought-provoking-papers-on-capacity.html)

I’ve had a problem ever since Steven had a mental capacity assessment in 2010, to assess whether he had the capacity to decide where he wanted to live. It was the first time in my life that I’ve seen decision making under such scrutiny; a professional panel not only judging if somone has the capacity to make a certain decision but insisting the person demonstrate their decision making function. And even then, there was the strongest feeling that the professinal may decide the wrong decision has been made for the wrong reasons. It felt very scary.  It seemed very clear to me that Steven was making himself very clear what his opinion was, albeit that it was not the decision the LA wanted him to make. He didn’t even need to be asked; he expressed his opinion that he “wanted to live in the Uxbridge house” several times each day and every day. I didn’t know until we went to court, how the referral from the LA to the psychiatrist had been made; it turned out both the social worker and her manager wrote to the psychiatrist. This is what Justice Peter Jackson had to say about the referrals in his judgement:

 77. “Again on 21 April, the social worker wrote to Steven’s psychiatrist, seeking advice. The letter said

    1. “my overall concern is that Mr Neary wants Steven home. I have spoken to the other professionals involved in Steven’s support and the general views are that Steven would be better supported in an environment that could offer him clear boundaries, structured approach, as well as staff that could manage the behaviours that Steven presents.” The team manager wrote to the psychiatrist on 26 April in the same vein, saying: “Mr Neary snr is challenging most aspects of what is taking place; it is increasingly likely that this will end up in the Court of Protection as we have major concerns about the idea of Steven returning home to Dad’s to live. It is much more likely that we will be looking for a longterm placement for Steven as we feel that this would be in his best interests.” These letters hardly provided a neutral summary of events as a basis for professional advice. “

And when we got to the assessment, the psychiatrist phrased the options to Steven in several different ways but on 24 occasions, Steven answered that he wanted to live in the Uxbridge house. He came unstuck once when the doctor asked him: “which is better; the Uxbridge house or M House?”. It was the only time Steven didn’t answer the Uxbridge house but as I said to the psychiatrist, I think he was confused by the question – to him “better” is what you become after you’ve been ill. Steven was also challenged to give reasons why he liked the Uxbridge house and he came up with five reasons: like to  live with Dad; like to watch my DVDs; like to listen to my CDs; like to play on my computer; like to see my friends. He only came up with one reason for M House (watching TV – which is the only answer he could have given because that is all he did there). So, by the end of the 2 hour assessment, I believed that not only had Steven been very clear in making a decision; he had also been able to demonstrate that he could explain the reasons behind his preference. He failed the assessment.

It appears to me that the emphasis in a mental capacity assessment is always on a cognitive decision-making process; a feeling based decision or a gut based decision is not considered worthy of capacity. And that’s my big problem because that is a ludicrous way of expecting any human being to make a decision.

I work as a counsellor, and typically in that field the two stock, cliché questions from counsellor to client are: “how do you feel about that?” or “what do you think about that?”. The more I do this work, I know that the question that I ask the most is: “what does your gut have to say about that?”. The head, the heart and the gut – we have to use all three and listen to all three when making a major life decision. Obviously we have to engage the head and look at the pros and cons of the options open to us. But our head can’t be the only organ used because it edits stuff. Likewise, it’s important to engage the heart and consider how we feel about the choices but we can get overwhelmed by our feelings and sometimes can’t see the wood for the trees. For me, the gut is the most reliable of the organs we use in our decision-making process – it’s where our truth lies. We may not always hear the answer we want but we will receive the truth. It gets tricky though because sometimes it’s very hard to communicate to others what we have heard from our gut, as the gut has a language all of its own. And if I’m in a mental capacity assessment, I know that I’ve got to do my best to express myself and lets face it, professionals tend to be at their most comfortable with a cognitive argument.

Every day for the past 14 years I have sat in a counselling room with people wrestling with huge life changing decisions; do I leave my wife; do I change my career; do I move to be nearer the family; do I give up drugs; do I want to confront the person who sexually abused me; do I try to get to grips with my obsessive compulsive disorder (The list is endless)? I don’t have any formal research statistics to support this statement but the vast majority of people I have seen, end up following their gut decision, wherever that decision may lead them. I have been seeing a woman who has been trying to decide whether to resolve a nasty work situation by going to an industrial tribunal. We’ve spent weeks weighing up the pros and cons of that option, and she often ends up thinking that she probably wouldn’t be successful. We’ve examined how she feels about the choice and then her feelings of rage, sadness and impotency overpower her. The other day, I asked her to see if her gut had a take on all of this. She immediately looked startled. She smiled and said the response she got was: “Go for it. It’s going to be bloody hard and you may get bruised but you may come out of it a much stronger, wiser person”. And that is what she is going to do. I wonder how that would stand up at a mental capacity assessment.

One other thought – we are also allowed not to make a choice too. And we’re allowed to go for any easy option because we don’t want the hassle of the harder one. Or perhaps we are too fearful to make a decision. That is okay too.

But a disabled person, undergoing a mental capacity assessment isn’t allowed these human traits of uncertainty, decisions based on fear, and most importantly, decisions from the gut. I could choose tomorrow, to leave everything I know and go and travel the world in a camper van. It could be a terrible decision but i can do it. A disabled person wouldn’t be allowed to make that decision. That can’t be right.

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From → Social Care

One Comment
  1. anonymous permalink

    Do we, in this country really understand the meaning of The Family Unit? And in choosing to keep vulnerable loved ones close to the family, in the long term saves money…………And heartache…..

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