Search results

Brain Injury Case Managers (BICMs) work closely with individuals with Acquired Brain Injury (ABI), assessing needs, structuring rehabilitation interventions and providing support, and have significant experience of clients with impairments to decision making. The purpose of this paper is to explore the application of the Mental Capacity Act (MCA) and its guidance when applied to ABI survivors. This research aimed to: first, highlight potential conflicts or tensions that application of the MCA might pose, and second, identify approaches to mitigate the problems of the MCA and capacity assessments with ABI survivors. It is hoped that this will support improvements in the services offered.

Using a mixed method approach, 93 BICMs responded to an online questionnaire about decision making following ABI. Of these, 12 BICMs agreed to take part in a follow-up semi-structured telephone interview.

The data revealed four main themes: disagreements with other professionals, hidden disabilities, vulnerability in the community and implementation of the MCA and capacity assessments.

The findings highlight the need for changes to the way mental capacity assessments are conducted and the need for training for professionals in the hidden effects of ABI.

Limited research exists on potential limitations of the application of the MCA for individuals with an ABI. This paper provides much needed research on the difficulties surrounding mental capacity and ABI.

The new Mental Health Act 2007 substantially amends the Mental Health Act 1983. In this article, some of the most important changes are highlighted, including changes to the definition of mental disorder, the new professional roles of approved mental health practitioner and responsible clinician, and the new powers for Supervised Community Treatment. The likely impact of these changes for people with learning disability and professionals working with them is discussed.

The purpose of this paper is to review safeguarding adult reviews (SARs) pertaining to individuals with acquired brain injury (ABI) since 2014. This extended literature review also explores the lessons and recommendations from these reviews in relation to social work practice within the UK.

The literature review reported and discussed findings across reviews and then used a thematic analysis to synthesise the findings and recommendations from the SARs reviews.

This paper identified four main themes: a lack of awareness of the needs of those with ABI and their families and around the symptoms and nuances of brain injury, particularly executive impairment and mental capacity, among social workers; poor interdisciplinarity led to a lack of shared communication and decision-making with professionals with such knowledge; a poor understanding of aspects of the mental capacity legislation, particularly surrounding unwise decisions, led to inappropriate or absent mental capacity assessments; and a lack of professional curiosity led to a lack of action where intervention or assessment was required.

This review identifies significant shortcomings in social work practice, education and training within the UK with regards to ABI.

This paper provides recommendations to current social work practice and highlights the need for significant improvements in pre-qualification and post-qualification training and supervision of social workers.

To the best of the authors’ knowledge, while there have been extensive reviews conducted on SARs, this is the only review that has focused solely on ABI.

The purpose in writing this paper is to highlight the lack of knowledge of many who are involved in capacity assessments, especially non‐professionals such as carers of the learning disabled, and the view that current guidance for capacity assessments does not take into account issues of emotionality.

The approach is to discuss current guidance and practice, and to offer academic criticism and explanation.

The findings include the discovery that the Mental Capacity Act 2005 Code of Practice suggests that healthcare professionals and family/carers may undertake assessments of decision‐making capacity, yet the guidance it provides for their doing so overlooks salient issues. Many of those involved in the daily lives of those, who may lack decision‐making capacity (and thus be seen as legally incompetent) such as the learning disabled, demented, mentally ill and neurodiverse, must decide whether to respect their decisions as competent, or to disregard the decisions on the grounds of incompetence and to act in the person's best interests. As many will lack training in their clinical and legal responsibilities and liabilities, it is crucial that they, and those they care for, are protected by not only an increased knowledge of mental capacity legislation and practice, but also how it may apply to questions of emotionality and neurodiversity.

This paper expands and builds on the authors' previous research into including emotionality in assessments of capacity, and will be of use to practitioners in the field of learning disability, and other psychiatric specialities.

This paper aims to highlight the challenges that case managers face in accessing appropriate statutory services and funding for young brain injured adults.

The paper uses aggregate case material, based on two years of case management with young adults with an acquired brain injury.

There is a need for separate, dedicated acquired brain injury services within local authority adult services. There should be a greater emphasis on assessments of functioning and decision‐specific mental capacity for clients with acquired brain injury rather than simplistic assumptions of capacity. Health and social welfare professionals in this field need a knowledge of the law related to benefits disregard and mental capacity, including recent case law. The statutory complaints system can provide redress where statutory services have been wrongly withheld.

Case managers need to keep up to date with the case law and application of health, social welfare and mental capacity legislation in order to ensure clients' rights and access to statutory services and funding.

This paper provides a subjective account, and analysis, of the reality of independent case managers working proactively, pragmatically and intensively across multidisciplinary and multiagency settings in the pursuit of clients' statutory rights.

The Mental Capacity Act (MCA, 2005) provided a new legal framework for decision-making practice in England and Wales. This study aims to explore qualitative research on practitioners’ knowledge and experiences of the MCA in health and social care settings to inform practice and policy.

Four electronic databases and Google Scholar were searched in November 2019 for peer-reviewed, qualitative, English language studies exploring practitioners’ experiences and knowledge of the MCA in health and social care settings. Nine studies were included and appraised for methodological quality. Data were analysed using thematic synthesis.

Data revealed both positive aspects and challenges of applying the MCA in practice within five main themes, namely, travelling the “grey line”, the empowering nature of the MCA, doing the assessment justice, behaviours and emotional impact and knowledge gaps and confidence.

The fundamental principles of the MCA appear to be adhered to and embedded in practice. However, practitioners find mental capacity work remains challenging in its uncertainties. While calling for more training, they may also benefit from further MCA skills development and support to increase confidence and reduce apprehension.

This is the first systematic review to synthesise qualitative literature on practitioners’ experiences and knowledge of the MCA. Findings offer insight into practice experiences of the MCA and provide a basis for the development of training and supervisory support.

The purpose of this paper is to provide a brief overview of the Law Commission’s final report and recommendations on the reform of the deprivation of liberty safeguards under the Mental Capacity Act.

Summary of main report.

The proposals contained in the Law Commision Review and proposals for law reform are outlined.

This is a summary.

Services for people with intellectual disabilities in the UK have evolved over the years from hospital-based care to more community provision. There are multiple reasons for these changes, however, often it was due to changes in social policy or following a scandal in provision. The paper aims to discuss these issues.

Providing services to meet the health and social care needs of people with intellectual disabilities is well-established in the four countries of the UK with support from legislation. There are often specialist mental health and social care teams. Dedicated professionals work with people with intellectual disabilities who experience mental health problems with a focus on support in the community. A range of services for children and adults and for offenders exist across the UK that often vary in composition and structure.

The challenges in providing mental health services for children and adults with intellectual disabilities in the future include recruitment and training of the workforce with the remit of enhancing community support and reduced in-patient care.

This paper helps the reader to understand how ID mental health services are organised in the UK.

This paper gives a summary of the ID mental health services in the UK. Even though there are various papers looking at different aspects of mental health services for people with ID in the UK, this paper brings all that information together to help reader get a better understanding of the mental health services for people with ID.

The purpose of this paper is to review a case of a man with a mild learning disability and autistic spectrum disorder who successfully appealed against a Deprivation of Liberty Safeguards authorisation under English law.

The authors wanted to identify the factors contributing to the individual’s deprivation of liberty and subsequent successful appeal. The authors examined the accounts from the experts involved on each side of the case including different views on the person’s capacity to make certain decisions. The authors examined several of the individual’s psychological and psychiatric assessments. The authors interviewed the individual on two occasions: once during the appeals process, and following his successful appeal.

The authors identified several reasons as to why the individual was successful in appealing against the Deprivation of Liberty Safeguards. First, the individual was able to seek legal support to appeal independently. Second, experts involved on each side of the case had differing opinions regarding capacity to make certain decisions. Third, the indication for the Deprivation of Liberty Safeguards was subsequently declared not valid. Finally, the authors found that the quality of life and psychological well-being for the individual improved following removal of restrictions.

The authors highlight the wider issues relating to an individuals’ rights to challenge authorisations in the Court of Protection as well as to future considerations and directions of the Deprivation of Liberty Safeguards legislation in light of evolving case law.

The authors highlight the importance of empowering patients in matters relating to their care and treatment, as well as protecting their human rights, dignity and autonomy.

The authors examine the barriers to challenging Deprivation of Liberty Safeguards authorisation and the ever-evolving Deprivation of Liberty Safeguards process.

Deprivation of Liberty Safeguards (DoLS), as part of the Mental Capacity Act 2005 (DoLS, 2007), was established to provide a legal framework for decision-making in respect of adults who lack capacity to make decisions in relation to their care and residence in England and Wales. The purpose of this study was to explore the DoLS decision-making process from the perspectives of health and social care practitioners when working with individuals with an acquired brain injury (ABI).

A total of 12 health and social care practitioners were interviewed in 2019–2020 about their experiences of using and making or supporting decisions in the DoLS framework with ABI survivors. Data were analysed, and a tentative explanation of variations in DoLS decision-making was developed.

Three distinct approaches emerged capturing different decision-making styles (risk-averse, risk-balancing and risk-simplifying) which appeared to influence the outcome of DoLS assessments. A range of mediating factors seemed to account for the variability in these styles. The wider contextual challenges that impact upon practitioners’ overall experiences and use of DoLS processes in their ABI practice were noted.

The findings highlight a need for changes in practice and policy in relation to how DoLS or similar processes are used in decision-making practice with ABI survivors and may be relevant to the implementation of the Liberty Protection Safeguards that are replacing the DoLS system.

To the best of the authors’ knowledge, this is the first study to explore accounts of DoLS decision-making practices in ABI service.