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Straight From The Gut 2

December 19, 2012

Following last week’s blog post on determining mental capacity ( and the blog by Lucy Series that inspired it), I have been blown away by the messages I’ve received and the conversations that have followed from it. There appears to be a very real interest in incorporating gut/intuitive responses into mental capacity assessments alongside the more measurable, cognitive responses. The general view is that this has to become part of the MCA so that it levels the playing field for the learning disabled. In fact, as one professional from the field commented, it has to happen because as things stand at the moment, to solely rely on cognitive decision-making functioning is discriminatory. The non learning disabled can draw on many processes when making decisions; why can’t the learning disabled?

The very nature of a mental capacity assessment and the fact that they tend to be applied to the very big life decisions puts an enormous unfair burden on the person being assessed. The MCA requires a person to be able to express and explain their cognitive process about the important decision to a collection of professionals, who may have already judged what they believe the “right” decision to be.

Just imagine that you were required to consult, be assessed and get agreement from a body of professionals if you had to make any of the following decisions:

  • where you want to live.
  • how you spend your money.
  • whether, and where you go on holiday.
  • whether you can marry the partner of your choice.
  • whether you can have sex with the partner of your choice.

Even if the non learning disabled were prepared to put themselves through this rigorous scrutiny, think how night impossible it would be if you had to produce a cognitive, reasoned balance sheet for all of these decisions. You can’t bring intuition into it; you can’t bring feelings into it – your reasoning parameters are extremely narrow. But this is the requirement for the learning disabled, albeit borne out of an incentive to protect them.

I am advocating that assessment encompasses other processes by which people make decisions; namely their gut intuition and their feelings. Not only should the assessment include these processes but that they should carry as equal a weight as the more measurable, cognitive processes.

Perhaps the big problem is the fundamental perception of an “assessment”. An assessor asks a question and the assessed is expected to supply an answer. This happens usually in the stark setting of a psychiatrist’s office. That may be a tiny bit restrictive! by all means, ask questions but be prepared to accept that some of the responses may be hard to articulate from a reasoned position. Because the answers come from the gut or the heart and not from the head.

I would suggest that it’s futile to try to determine something as important as mental capacity in a formal 90 minute interview. It requires much more time in both formal and informal environments; carefully recording the person’s verbal, physical, emotional, intuitive, behavioural reactions. If a learning disabled person doesn’t understand or respond to your question, possibly, just possibly, the problem may be in the way you’ve asked the question.

We need a new model in assessing mental capacity. Anyone interested?

 

Postscript:

Here is a conversation I heard on the bus this afternoon between Betty and May:

Betty: “I still can’t decide if we’re having turkey or pork”.

May: “You’re cutting it a bit fine”.

Betty: “I like the taste of pork but I’m not too keen on the smell”,

May: “Have turkey then”.

Betty: “Bob’s gone off it. Do you remember that year he was queer on it?”

May: “We’re having a duck”.

Betty: “DUCK?”

(Long pause)

Betty: “What you having duck for?”

May: “My mother loved a nice duck”.

Betty: “Ah. There you go then”.

 

An analysis of their decision reasoning:

No to pork – unpleasant smell.

Not to turkey – turned Bob queer.

Yes to duck – mother loved it.

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