Am I supporting the people I care for in making their own decisions?

The New York Convention includes the right to make decisions as one of the fundamental rights of people (Art.12). All people have the right to decide for themselves , to have their decisions respected by others and to have these decisions recognized as valid. This includes not only making formal decisions, such as getting married, signing a contract or buying property, among others, but also informal decisions in their day-to-day lives.

It is important that people can make their own decisions in life, as these decisions:

• They define their personality and help them develop their identity and role in society.
• They empower them, helping them not to depend on others and to participate in the community on equal terms and develop positive and healthy relationships.
• They help you take responsibility for your life and face difficulties and obstacles to your well-being.
• It allows them to have more control over their lives, reducing the risk of finding themselves in situations of violence, exploitation or abuse.

The right to decide in the context of mental health

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Often, when people are treated in social or mental health services, they tend to experience unequal power dynamics that make them feel that they have a very limited ability to influence the care and attention they receive, while professionals have the authority to decide for them. For this reason, it is even more important, in these spaces, that professional teams adopt a supportive approach so that the person can also make decisions during their involvement with the service. Sometimes, they may think that they already adopt this supportive attitude, but often they decide for it unconsciously.

In social or mental health services, there tend to be unequal power dynamics that make people feel that they have a very limited ability to influence the care and attention they receive.

What should the support we provide them be like?

In this new approach, the support we provide to the people we serve must:

• Empower them and provide them with sufficient and understandable information so that they can decide about their lives (including about the care and treatment they receive).
• Countering power imbalances . This is achieved when people working in these services attend to the person's values, expectations and preferences and act accordingly.
• Promote self-reflection among professionals on how, unintentionally, their behaviors may be an obstacle to the right to decide for the people they care for.

Am I supporting decision-making? Checklist

The World Health Organization (WHO) in its QualityRights training materials provides a useful checklist for professionals to assess whether they are providing this support. This list, to which other measures can be added, includes aspects related to:

• The information provided to the person. It is necessary to verify that the person being treated has all the information they need to be able to make a certain decision, that they have all the information they request, and that they have been informed about the options or alternatives available.
• Communication of information. Information must be communicated in a way that the person can understand. In some cases, this may involve using simpler and clearer language, visual aids and also paying attention to non-verbal communication. Sometimes, other people can help facilitate communication (family member, support professional, interpreter, etc.), but we must ensure that the person wants and accepts this help.
• The comfort of the person. For people to be able to make decisions freely, they need to feel safe and comfortable in their relationship with the professional. For this reason, it is important to also identify at what times and places the person feels most comfortable and can understand things better and, if necessary, assess whether it is possible to postpone the decision and wait for a time when the circumstances are more suitable for them.
• The support provided to the person. It is necessary to see if someone else can help the person express their opinion or preference or make a decision.

Good practices in supporting decision-making

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Other things we can do from the services to provide this support

Social and health services that care for people with mental health problems can also carry out actions that facilitate the people being cared for to make decisions in the same services.

Some examples could be:

• Develop and implement organizational policies to promote the right to decision-making.
• Inform, train and empower professional teams in decision-making support and allow debate on this topic.
• Ensure that people being treated are systematically asked what their preferences are and that they are respected.
• Promote the participation and involvement of service users in the mechanisms for evaluating and designing improvements to the service itself, with the support they may need in each case (such as participation committees, analysis and co-design processes, or through satisfaction surveys).
• To facilitate contact between the people receiving care and external sources of support and information , such as local social entities, support groups and mutual aid groups, etc.