Making Best Interests Decisions: People and Processes

Williams, Val; Boyle, Geraldine; Jepson, Marcus; Swift, Paul; Williamson, Toby and Heslop, Pauline (2012). Making Best Interests Decisions: People and Processes. Mental Health Foundation, London.



The 2005 Mental Capacity Act (MCA) in England and Wales is innovative in formulating a principled, legislative framework to protect the rights of individuals in decision making, in the assessment of capacity and the making of best interests decisions. According to the Mental Capacity Act, a person can be assessed as not capable of making a particular decision, in which case that decision should be made for him/her, according to his or her best interests. This situation has a direct impact on the rights of those people with impairments that might affect their decision making capacity, and in the current report, we focus particularly on those with dementia, mental health problems or learning disabilities.

Research about best interests decisions since the Act has highlighted confusions in practice (Myron et al,2008), concerns about tokenism (Donnelly, 2009) and challenges relating to the resolution of conflicts (Joyce, 2007). Most of the research carried out about the MCA has been about individual aspects of the Act, and a set of resources was produced for SCIE (2008-9) on the basis of research in particular areas of the application of the MCA (McDonald, Dawson & Heath, 2008; Williams, Jepson et al, 2008; SCOPE, 2009). There are still several unanswered questions about how the best interests principle is being followed in general (Stanley and Manthorpe, 2008) and how it is interpreted in major life threatening situations (Hegde et al., 2006).

The current study (BIDS) was therefore funded by the Policy Research Programme (PRP) at the Department of Health, three years after the implementation of the Mental Capacity Act, in order to examine the professional practices involved in best interests decision making. The study was carried out by a multi-centre research team from the University of Bristol, the University of Bradford and the Mental Health Foundation. The purpose of BIDS was to gain robust information and understanding of the extent to which the law on Best Interests and the associated MCA guidance was being implemented in a wide variety of settings. In this opening section we will outline the aims of the study, with some brief points about the methods used and the implications of the sampling we undertook.

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