Vicky Yeates worries about the future for her 31 year old daughter. She met two young men whose journey to independence offers some reassurance about her daughter’s future but whose stories show how excessively risk-averse implementation of the Mental Capacity Act can be a barrier to success…
Dan and Steve have learning disabilities; both have had chaotic young lives and at times posed a challenge to their South Wales local authority.
I met 30-year old Dan who has coped with a disruptive family environment and his own problem with alcohol for a number of years. He has had various brushes with the law. Dan went from one institutional type setting to another but all broke down. He felt no one listened to what he wanted. At one point he was placed in living accommodation away from the town and community he knew. The reason behind this decision by social services was because he was viewed as ‘high risk’. His previous misdemeanours had earned him a reputation with the authorities as someone who was ‘difficult to manage’. I found this very difficult to square with the charming, eager to please person I encountered!
Play to successes
Around 2005 his local authority commissioned the providers United Response to work with him in a more positive, less risk averse way. Part of this strategy was to listen to Dan’s needs and play to his successes rather than dwell on his past disappointments. It was important to Dan to live in his home town area, close to his father and the community he knew. He was allocated a flat, an important step towards greater independence within his community. This worked well but when Dan experienced some difficulties with his tenancy United Response took the view that things can go wrong for anyone and resolved to keep supporting him, finding him alternative accommodation with enhanced support. This positive, solution-focused approach is what most of us need when life throws a curve ball at us.
West Wales or nowhere
Then I met Steve who had also lived in a number of institutional type arrangements, none of which were suited to his needs. Again, it was important to Steve to have choice as to where he lived and he most definitely did not want to live out of his home town area, in a highly controlled setting where he had little say in key decisions in his life. For example, he was told by the staff that he had to go on holidays to West Wales. Steve did not want to do this so he resisted. “It’s not my thing”, he said.
United Response worked with Steve to encourage him to develop life skills to help him mature and foster a more disciplined approach to his life. Significantly, Steve has conquered his excess drinking – a major success for him. He works in the local resource centre as a cleaner/helper. He has a support worker who helps him budget his money, monitors his progress and support him through any blips.
Risk aversion before rights?
This must surely go to the core of successful social care support – listening, encouraging, ascertaining what each person’s ‘thing’ is – then involving them in choosing their path.
There will be times when decisions have to be made for and with the many vulnerable adults such as Dan, Steve and my daughter, who may not have full capacity in all matters. The prevailing legislation – the Mental Capacity Act 2005 – has at its core a set of noble principles. Decisions made on behalf of those unable to make a decision must be made in their best interests and in the least restrictive manner. Yet, a decade on, there are concerns that many people are receiving neither their legal rights nor the person centred care the legislation was designed to support.
Despite the original visionary nature of the legislation implementation has suffered through a prevailing culture of paternalism which puts risk aversion before individual rights. Implementation of the Act often shows a lack of understanding and awareness of person-centred care. However, if vulnerable people with compromised capacity are to achieve equal citizenship and their autonomous wishes are to be respected, they ought to be allowed to take risks, make mistakes, experiment and change course in their lives, just like every other citizen.
My daughter currently lives at home and I would like to think that for her – and others in her position – there can be a positive way of working with her to establish what her ‘thing’ is, facilitate her to live as independently as possible and avoid risk-averse decision making which may restrict her life choices. I am grateful to Dan and Steve for allowing me into their lives and helping me to worry a little less.
Vicky Yeates is a qualified solicitor and retired senior lecturer in law at the former University of Glamorgan (now the University of South Wales) where she taught Mental Health law. She gave oral and written evidence to the Select Committee of the House of Lords Parliamentary Scrutiny Committee during the enactment of the Mental Health Act 2007.
