Supported Decision-making in the United Kingdom: Lessons for Future Success

Abstract

This article summarises key aspects of the Mental Capacity Act (2005) in England and Wales. In particular, it focuses on the implementation of this Act and the lessons that can be drawn from the situation in the United Kingdom by those currently developing legislation around supported decision-making. The Mental Capacity Act (2005) has five core principles: (i) a presumption of capacity; (ii) individuals being supported to make their own decisions; (iii) unwise decisions; (iv) best interests; and (v) the least restrictive option. Although some good practice of supported decision-making is available, the House of Lords Select Committee Report (2014) identified that the Mental Capacity Act was currently very poorly implemented, with core issues including: a lack of understanding of the Act's principles, in particular, by health and social care professionals; a continuing prevalence of paternalistic substitute decision-making rather than the intended supported decision-making; and a general lack of change in the attitudes and culture from a caring and protective to an enabling and empowering approach. They also found perversion of the principles of the Mental Capacity Act, with the assumption of capacity being used to justify not providing services. The article concludes with a suggestion of a system for facilitating supported decision-making, as well as consideration of what is needed to change the culture.