A social approach to decision-making capacity: exploratory research with people with experience of mental health treatment

Abstract

This paper reports on exploratory, qualitative research conducted with eight people with experience of mental health treatment about their understanding of decision-making capacity. While acknowledging that there are times when mental or emotional distress can interfere with the capacity to make decisions, participants described how their capacity can be reduced by a set of social and environmental factors. These factors include the lack of treatment options available from which to choose, lack of trust of the information provider, inaccessible information, the effects of medication that literally ‘stops your ability to think’, lack of empathy with mental or emotional distress, and lack of time to process information. Participants highlighted the issue of power and powerlessness when describing how incapacity is determined within mental health services. Participants’ articulations of capacity in relation to mental health are in accord with a social model of disability approach to capacity.

Keywords:

• decision-making capacity
• legal capacity
• competence
• social model
• mental health
• disability

Notes

1. The language used to discuss mental health and the labels used to describe participants in the system are highly contested. This article will use the phrase ‘people with experience of mental health treatment’. This definition focuses on identifying those who have been in contact with mental health services while setting aside the question of whether their experience is a biological disorder, psychological problem or social construction.