Exploring Constructs of Capacity in Learning Disability Contexts: Power, Protection and Institutional Practices

Abstract

The Mental Capacity Act (2005) is a legislative framework designed to promote autonomy and support those who may struggle to make decisions for themselves. Previous research suggests that the implementation of the Mental Capacity Act raises a number of challenges for professionals (McVey, 2013; Walji, Fletcher & Weatherhead, 2014) and that applying the Act in learning disability settings may be particularly complex (Brown & Marchant, 2013). The concepts of ‘capacity’ and ‘learning disability’ draw on knowledge across legal, philosophical and psychiatric discourses, which may imply different practices for professionals. Semi-structured interviews were completed with eight professionals working in adult community learning disability services. A Foucauldian approach to discourse analysis was used to examine how capacity was constructed in professionals’ accounts of their experiences implementing the Mental Capacity Act. The discourses and subject positions available to professionals and people with learning disabilities were considered. Analysis of professionals’ accounts suggested that ‘legal’ and ‘rights’ discourses of capacity were oriented to. Knowledge of capacity was constructed as being limited to professionals, with families and service users often in need of further information on the Mental Capacity Act. ‘Legal’ and ‘rights’ discourses enabled multiple subject positions for professionals and people with learning disabilities. These positions allowed for both restrictive and empowering practices. Promoting subject positions of ‘personhood’ appeared to allow for alternative understandings of capacity, in which decision-making is an interdependent rather than independent process. This study suggests that capacity assessments are sites of tension between multiple discourses. Co-constructing meanings of capacity within services and across disciplines may allow for the development of best practice, and facilitate supported decision-making practices with people with learning disabilities.