All practicable steps: The forthcoming Mental Capacity CEN for SLTs

Many moons ago (five years to be more precise) I attended a study day for a group of speech and language therapists with a special interest in acquired neurological conditions. The theme of the day was the Mental Capacity Act and its relevance to the profession. It was such an interesting day, and I made connections with people with similar interest in this fascinating and important area and with whom I have maintained contact with ever since. Yet the discussions on this day were rather split. Many therapists at the event took the view that SLTs should not be advertising themselves as willing to assess people’s decision making capacity for fear of being flooded with an overwhelming number of referrals that we wouldn’t know how to cope with. Others felt quite the opposite, suggesting that supporting decision making and issues related to this should be part of our core business.

Since then, work around the implementation of the Mental Capacity Act in health and social care settings, the NICE guidelines and RCSLT guidance for example, has made it clear that all professionals need to understand the basic principles of the Mental Capacity Act. All professionals need to be aware that a person with an impairment of mind or brain may have difficulties in decision making and that should there be any evidence of this then an assessment of decision-making capacity may need to be undertaken. This assessment should only be undertaken if all reasonable steps to support decision making have been taken. And if they have been shown to lack capacity then a decision may be made in their best interests, depending on the decision at hand.

So what are speech and language therapists doing in clinical practice? There has been some data collected on the practices – a survey of SLTs across the UK was published last year (McCormick, Bose & Marinis, 2017, Aphasiology, 31(11), 1344-1358). This has collated some information on the roles that SLTs are taking (sometimes being assessor and decision-maker but often not being utilised perhaps because others don’t know about the breadth of our role) and the training that they are delivering to other professionals (mostly to allied health). That said there has been lots of innovative work done, and lots of work that needs to be done to develop practice further. Some SLTs are even specialising in Mental Capacity work both within and outside the NHS.

But a number of SLTs felt they needed a bit more support- from within the profession. A tweet set out by @jothespeechie illustrated that there was a lot of interest in such a group (over 100 people responded to this tweet). Amongst other things responses highlighted that SLTs would like:

  • To share practice from across the discipline
  • To share resources within the discipline and beyond
  • To spread the word about our role to other disciplines
  • To develop assessment practices and processes
  • To refine and define the role of the SLT in relation to mental capacity
  • To consider training- of new graduates and undergraduates in this area
  • To get regular updates on legislation and policy development
  • To influence research priorities in this area

And yesterday a group of SLTs gathered at UCL to put their minds together to get something off the ground. The team put together an application for RCSLT for the aptly named Mental Capacity CEN. We assigned a Chair (our fearless leader @jothespeechie), treasurer, secretary, membership secretary, social media secretary and study day organisers. We planned methods of disseminating information- look out for our forthcoming twitter handler, WordPress site, Instagram and Facebook pages. We have even started thinking about our forthcoming study days and have a list of ideas for potential presentations from existing committee members as well as individuals external to the group. We would like to host workshops and discussions. We are even planning to put together some work that might be published in the Bulletin magazine to disseminate anything we develop such as competencies or resources.

On a personal note I feel that the energy in the meeting was super exciting. It is important for us to have a voice in issues related to decision making and mental capacity. The legislation describes the functional test of decision making in relation to four domains- understanding, expression, retention and weighing up a decision. As a profession we have been studying at least 50% (more in many ways) for many many decades. We understand the subtleties of language and communication (even with individuals without communication difficulties) better than many. We are able to modify language to plan, accessible and inclusive communication. We can detect bias and inference. I feel that this is just the beginning of what we might be able to do for the people we serve (our patients) as well as for our colleagues!

So keep watch – we will be advertising our study days soon!

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