By Meike Beckford
A few weeks ago on a cold and wet winter’s morning I found myself stood on the side of the A1 next to my rather poorly car, having just broken down. As well as the immediate concerns about getting the breakdown service out, getting my car to the garage and getting to that day’s board meeting, I was also a bit worried about what the verdict would be for the car. Sure enough, having had the car towed to the garage I got the call later that day that it was terminal – I was going to have to buy a new car.
We at Dosh do lots of miles travelling around visiting people we support, delivering training and working with people across social care to promote best practice, so I needed some wheels back quickly! That weekend I went off to look at cars and came away with a new car, a much lighter purse and a lot of stress! This got me thinking about supporting people with decision making – if I were supporting someone in that situation in the future, what could I take from this experience?
We often support people and their circles of support to make financial decisions, whether it’s getting a car, going on holiday or planning weekly spending. At Dosh, we see lots of great work from support workers involving people in making their own decisions, but from our comfortable position of understanding these decisions we can often forget just how stressful this can be for people.
Why decisions can be difficult
- Situations create pressure – even if what we are saying isn’t putting on pressure (the salesperson gave me the information and allowed me time to decide), the situation (a sales environment) can do that anyway. Time restrictions, the environment and the people present can all add to the pressure someone feels, even if it’s not intentional.
- Time – sometimes, as with my car, we have to make decisions quickly, meaning we can feel rushed and unable to properly consider things. We are running on adrenaline which is great for quick reactions, but not so good for considering options.
- Understanding and using information – stress makes you less able to take in information and weigh it up. The Mental Capacity Act tells us this is what we need to do to make a decision and yet this can be one of the first things to go if we are stressed and no longer ‘thinking straight’. When trying to choose between cars I found it really difficult to take in new information, weigh it up and decide on the best option.
- Just wanting to get out – the dreaded upselling! Once you’ve said yes the stress doesn’t stop – you want to get out of that situation as soon as possible and saying ‘yes’ is often the quickest way to do that. This is certainly the case in social care with people used to submitting to professionals’ opinions rather than having time to form their own.
- Stress reduces your ability and confidence to communicate well – this could include asking questions to help understanding, or expressing disagreement or hesitation. Communicating a decision is a key part of mental capacity, but stress can prevent clear communication.
- Aiming for a decision – whilst this is inevitable to an extent, framing it in that way makes a definite ‘yes’ or ’no’ more likely than ‘not sure’ or ‘I need more time’. Decisions are easier if you narrow the choice, but that also reframes the decision and excludes wider options or alternative ways of thinking.
What we can do when supporting someone to make a decision
- Understand someone’s signs of stress and stop the process if necessary. People communicate in many different ways – make sure that someone who knows them well is there to support them so they can understand any communication, whether verbal or through behaviour.
- Be aware of the power in the room – if professionals are at a meeting and they traditionally make the decisions people may feel they need to agree with the ‘expert’. Some people will likely be seen as more knowledgeable or important, giving their views more weight and influence – people will want to say what is ‘right’ and agree with the expert.
- Think about question phrasing – if it requires a simple yes/no answer (a closed question) or suggests a particular answer (“shall we…”) you may prejudice the answer.
- Use time – as supporters we can force more time into the situation if we observe that someone’s ability to make decisions has reduced. Put in a break and remove the person from the situation for a while. As supporters, we can say stop where the person, due to stress or limited communication, may not feel able to (but don’t only use this if they are disagreeing with you!)
- Be aware of your own opinions and biases when presenting information and options and explaining things to people. Involve different people and information so you are not unconsciously leading the person.
- We still have to make decisions – it may be stressful but that doesn’t mean we should stop involving people, the more they are involved the more likely they are to be happy reaching decisions, whether they are choosing themselves, or we are choosing in their best interests.
Ultimately, decision-making is hard for all of us and we need support to manage it whether we have a learning disability or not. I did end up with a good car, but had I been less stressed I might have felt less forced into a decision I wasn’t sure about!
At Dosh we support people with decisions about significant spending, including through our best interest decision process. We also deliver training and consultancy on finance awareness and best interest decisions. If you’d like to talk to us about our support or training, contact Steve or Meike, email firstname.lastname@example.org or call 0300 303 1288.
For more information on the Mental Capacity Act try the SCIE MCA resources, read the NHS guide to mental capacity, and download the MCA Code of Practice.
Meike is the Financial Advocacy Manager for Dosh. You can follow her on twitter @MeikeB88.