Mental capacity assessment with people with aphasia: understanding the role of the speech and language therapist

ABSTRACT

Background

The law is leading a cultural shift away from medical paternalism towards shared decision-making with patients. A person’s ability to make decisions about their care and treatment is regulated through mental capacity law in the UK. A verbal interview is used to judge a person’s capacity. People with aphasia (PwA) may retain the cognitive ability to make decisions but have difficulty understanding information and expressing their wishes. PwA are at risk of having their capacity status misidentified without the support of skilled communication partners such as Speech and Language Therapists (SLTs). Currently, little is known about the SLTs’ role in capacity assessment for PwA in the UK.

Aims

This research aimed to explore UK SLTs’ experience of mental capacity assessment in PwA, focusing on the principal challenges and facilitators and the role SLTs play in the assessment process and within the multidisciplinary team (MDT).

Methods

A qualitative approach was taken using semi-structured interviews to explore SLTs’ perspectives. 13 interviews were conducted with SLTs from England and Scotland. Data were analysed thematically.

Results

Participants reported that facilitators were routine decision types, patients without complex co-morbidities, availability of time, close collaborative teams where the role of the SLT was valued, and trust existed in the relationship with the PwA and their carers. Challenges to the process were infrequent decision types, patients with complex cognitive/communication impairments, lack of time, conflict with carers and the MDT, and lack of access to team support. SLTs inhabited a variety of roles in the process of mental capacity assessment. They were morally motivated to adopt supportive roles but were equivocal towards adopting assessor roles. Across the data set an ambiguous interpretation of terminology, processes and level of specialisation required emerged.

Conclusion

SLTs’ play a unique role in supporting PwA to exercise their right to autonomy. This study is the first to explore SLTs’ experience of mental capacity assessment across different UK jurisdictions. SLTs’ confidence in their role in capacity assessment is growing although the complexity of the process continues to present challenges. Broader training in legal and conceptual aspects of mental capacity would support a clearer understanding of assessment procedures and facilitate SLTs to promote their role more broadly with their colleagues.

KEYWORDS:

• Aphasia
• mental capacity
• autonomy
• speech and language therapy
• shared decision making

Acknowledgments

I am grateful to the following individuals for their help during the development of this research: Ruth Sullivan, the British Aphasiology Society, Dr Lynn Dangerfield, Rebecca Holland-Lloyd, Dr Mark Jayes, Dr Anna Volkmer, Dr Suzanne Beeke and Dr Lisa Gould.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. England and Wales.

2. England only.

3. A similar role to Best Interests Assessor.