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Involvement and choice - you will be involved as much as you want and are able to be

Speaking to patients
'All contacts excellent and has given me loads of confidence regarding dealing with my condition.' Service User

Services work best when the people who use them are involved in the care process.

We will take into account peoples diverse needs, particularly around communication and access, and respect your privacy, dignity and independence.

The service will protect your rights, as well as those of other people, and will protect you and others from harm wherever possible.

We will always try to make sure that people are involved as much as they want and are able to be, and have choices wherever possible, but choice may sometimes be limited by the services we have been commissioned to provide.

We want to support you to make informed choices through:

  • taking part in planning your own care and understanding the care, treatment and support choices you have

  • considering choices to promote and facilitate your recovery

  • being central to the decisions made around your care

  • having information to help you make informed choices and decisions about things like medication

  • being involved in working out what circumstances make your health worse, and using advance decisions if you want to, to say what you would like to happen

  • having family and carers involved in decisions about your care when appropriate.

  • using person-centred care processes

 

If you are not able to make decisions, we will help to protect and empower you. See below under 'Mental Capacity'

For local Advocacy services, please see below under 'Advocacy'

“You have the right to make choices about your NHS care and to information to support these choices. The options available to you will develop over time and depend on your individual needs.” “You have the right to be involved in discussions and decisions about your healthcare, and to be given information to enable you to do this.”NHS Constitution

'Good that you are sending out for feedback.' Service User

This would include you:

  • Being shown respect and treated with dignity

  • Being at the centre of your care and support

  • Feeling able to say what you think about the services you’re getting

  • Being fully involved in planning care, with family members/carers as care partners, and partner agencies

  • Being offered information about services and care (including medication) such as a copy of your care plan, in an accessible way, and be supported to make choices

  • Being asked to consent to treatment, unless other provisions apply

  • Accepting that other people you come into contact with have the right to respect, dignity and choice

  • Having the Core Care standards explained to you, or information available about them

 

This would include the service:

  • Taking account of differences in and barriers to effective communication including making provision for languages other than English.

  • Being aware that everyone's communication ability varies depending on physical and mental health and many other factors

  • Respecting your rights to privacy and confidentiality

  • Promoting equality, recognising respecting and valuing diversity

  • Applying principles of person-centred approaches in assessment, care planning, review and discharge

  • Telling you about the risks and benefits of any intervention or treatment, including the potential side effects of any medication

  • Identifying any networks of support you have

  • Protecting your interests where your capacity to make decisions is impaired

  • Offering opportunities for Self Directed Support, such as Direct Payments, Individual Budgets etc. where these apply, or signposting to agencies that can help

  • Listening to what care you do and do not want, including any Advance Directive or Statement of Wishes you make

  • Working within safeguarding procedures

 

We also comply with any legislation in this area, such as the Mental Health Act Code of Practice 2008 which says:

‘Patients must be given the opportunity to be involved, as far as is practicable in the circumstances, in planning, developing and reviewing their own treatment and care to help ensure that it is delivered in a way that is as appropriate and effective for them as possible. The involvement of carers, family members and other people who have an interest in the patient’s welfare should be encouraged (unless there are particular reasons to the contrary) and their views taken seriously.’   

We want to make sure you can access the information you need.

  • There is a glossary on the site that explains the meaning of any terminology that's not obvious 

  • If you need information in another language, click on the buttons at the bottom of the front page to translate the whole site, or contact us for a leaflet translation

  • If you prefer Easy Read, click here

  • If you need a care plan or other form translating, let us know

  • If you need the text larger to be able to read it better, click on the text size at the very top of the page - the bigger the letter A you click on, the bigger the text will get

Mental Capacity

Every day we make decisions about lots of things in our lives. The ability to make these decisions is called mental capacity. People may have difficulty making decisions some or all of the time. This could be because they have:

  • a learning disability
  • dementia
  • a mental health problem
  • a brain injury
  • had a stroke

 

If we are concerned that you may not have the capacity to make major decisions about your health and welfare (including personal care), property and financial affairs, or where you live, we will assess your capacity to make these decisions. If you are unable to make some decisions, the Mental Capacity Act says:

  • you should have as much help as possible to make your own decisions
  • people should assess if you can make a particular decision
  • even if you cannot make a complicated decision for yourself, this does not mean that you cannot make more straightforward decisions
  • even if someone has to make a decision on your behalf you must still be involved in this as much as possible
  • anyone making a decision on your behalf must do so in your best interests

 

The Mental Capacity Act (2005) provides a framework to protect and empower vulnerable people who are not able to make their own decisions. See below for a brief guide to the main provisions of the Act.

Service Users/Patients

Please click here for a booklet Making decisions: who decides when you can't? and information from the Royal College of Psychiatrists about Capacity and the Mental Capacity Act (MCA) or view information about consent to medical treatment from MIND.

Carers

Please click here to find out about Carers and the Mental Capacity Act and a booklet Making decisions: a guide for familiy, friends, and unpaid carers. Carers and advocates will normally be involved in planning care, and in any reviews.

Staff

Click here for the Mental Capacity Act Code of Practice and a booklet Making decisions: a guide for people who work in health and social care. Click here to subscribe to the Derbyshire Mental Capacity Act 2005 e-learning course or download the Making Decisions (Mental Capacity Act 2005) App. It is also important to read and refer to trust policies on Connect.

Derbyshire Independent Mental Capacity Advocate  or ONE Advocacy (Derby City) can help people who lack capacity. They provide statutory advocacy under the Mental Capacity Act .

Remember - any actions to protect or safeguard someone, and any Advance Decisions or Statements of Wishes, should be referenced in the notes and in the care plan

The Mental Capacity Act

The Mental Capacity Act (2005) provides a statutory framework to empower and protect vulnerable people  aged 16 or over who are not able to make their own decisions. It makes it clear who can take decisions, in which situations, and how they should go about this. It also enables people to plan ahead for a time when they may lose capacity, and replaces Enduring Powers of Attorney and Court of Protection Receivers with updated schemes.

The Act is underpinned by five key principles:

  • A presumption of capacity: every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise.
  • The right for individuals to be supported to make their own decisions: people must be given all appropriate help before anyone concludes that they cannot make their own decisions.
  • That individuals must retain the right to make what might be seen as eccentric or unwise decisions.
  • Best interests: anything done for or on behalf of people without capacity must be in their best interests.
  • Least restrictive intervention: anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.

 

Assessing lack of capacity

The Act sets out a single clear test for assessing whether a person lacks capacity to take a particular decision at a particular time. It is a decision-specific and time-specific test. No one can be labelled ‘incapable’ simply as a result of a particular medical condition or diagnosis. Section 2 of the Act makes it clear that a lack of capacity cannot be established merely by reference to a person’s age, appearance, or any condition or aspect of a person’s behaviour that might lead others to make unjustified assumptions about capacity.

  • If a doctor or healthcare professional proposes treatment or an examination, they must assess the person’s capacity to consent. In settings such as a hospital, this can involve the multi-disciplinary team (a team of people from different professional backgrounds who share responsibility for a patient). But ultimately, it is up to the professional responsible for the person’s treatment to make sure that capacity has been assessed.

  • A person’s capacity must be assessed specifically in terms of their capacity to make a particular decision at the time it needs to be made.

 

How do you assess capacity?

Use the two-stage test for capacity:

  1. Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (It doesn’t matter whether the impairment or disturbance is temporary or permanent)

  2. If so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made?

 

    A person is unable to make a decision if they cannot:

  1. understand information about the decision to be made (the Act calls this ‘relevant’ information);

  2. retain that information in their mind;

  3. use or weigh that information as part of the decision-making process; or

  4. communicate their decision (by talking, using sign language or any other means)

    The first three points above need to be applied together. If a person cannot do any of these three things,  they will be treated as unable to make the decision.

Best Interests

An act done or decision made for or on behalf of a person who lacks capacity must be in that person’s best interests. The Act provides a non-exhaustive checklist of factors that decision-makers must work through in deciding what is in a person’s best interests. A person can put his/her wishes and feelings into a written statement if they so wish, which the person making the determination must consider. In addition, people involved in caring for the person lacking capacity have to be consulted concerning a person’s best interests.

Advocacy is a way of giving people a voice. There are different models of advocacy:

  1. Self-advocacy: this is where people speak for and represent themselves, with some support
  2. Peer advocacy: where the advocate has common ground with the person being represented, such as shared experience
  3. Volunteer Citizen advocacy: Unpaid volunteers who represent the persons views
  4. Professional Advocacy: A paid trained advocate who provides advice and support

See Advocacy: Models and insight for more information 

If you need someone to help you have a voice in discussions, you might want to think about having an advocate. You can bring a friend, family member or carer, or use a volunteer or paid advocate.

Mental Health Advocacy and Human Rights from BIHR

Click her for Advocacy for ROMA people

Find an advocate anywhere in the UK at Action for Advocacy

Mental Health Act (IMHA) and Mental Capacity Act (IMCA) Advocacy Services

Specialist advocacy and representation is available for people with mental health problems who have substantial difficulty in being involved in their own care. This includes people who qualify under the Mental Health Act (IMHA service) and/or the Mental Capacity Act (IMCA service).

Contact:

  • Derbyshire -  Mental Health Act (IMHA service) and/or the Mental Capacity Act (IMCA service). Tel: 01332 623732. Click here for more information

  • Derby City - ONE Advocacy Derby - This service brings together all advocacy services in Derby. Tel: 01332 228748.  Click here for more information 

 

imca

Independent Mental Health Advocacy Service(IMHA)

From the 1st April 2009, changes in the law meant that some patients have a legal entitlement to the specialist help of an IMHA.  The service is available to anyone who is detained under the Mental Health Act

IMHA's help people to understand and exercise their rights in relation to the Mental Health Act, this can include representing them and speaking on their behalf in a variety of settings including ward rounds, CPA meetings and tribunals.  The Mental Health Act Code of Practice provides further information on the role, rights and responsibilities of the IMHA's. 

Advocates offer independent support to help people express their views and wishes in relation to the mental health services they are using or wishing to access. 

Click here to find out more about Derbyshire County IMHA Service
Contact details: Derbyshire Mind, Derby West Business Centre, Ashbourne Road, Mackworth, Derby, DE22 4NB.  Tel. 01332 345966. email enquiries@derbyshiremind.org.uk

Click here to find out more about Derby City IMHA Service
Contact details: ONE Advocacy, Stuart House, Green Lane, Derby,  DE1 1RS. Tel: 01332 228748.

Independent Mental Capacity Advocacy Service (IMCA)

From the 1st April 2007 the Mental Capacity Act established a new statutory scheme known as Independent Mental Capacity Advocacy (IMCA).  This provides additional safeguards for people who lack capacity to take decisions in certain specific, important situations and who are particularly vulnerable because they have no close relatives, friends or any other person to help to protect their interests.

There is a legal duty for health and social care professionals  to refer a person to the IMCA Service when specific decisions are being made and the person:

1.    Has been assessed as lacking capacity to make that specific decision, and

2.    The person has no family or friends who are appropriate or willing to be consulted on the decision in question

Which decisions require an IMCA?

Must refer for decisions about:

1.    Serious Medical Treatment

2.    Long Term Care Moves

May refer for decisions about

3.    Care Reviews

4.    Safeguarding Adults at Risk (in some situations even where the person has family or friends who can be consulted).

Click here to find out more about Derbyshire County IMCA Service
Contact details: Derbyshire Mind, Derby West Business Centre, Ashbourne Road, Mackworth, Derby, DE22 4NB.  Tel. 01332 345966. email enquiries@derbyshiremind.org.uk

Click here to find out more about Derby City IMCA Service
Contact details: ONE Advocacy, Stuart House, Green Lane, Derby,  DE1 1RS. Tel: 01332 228748

What is an advance decision?

The term advance decision (previously known as an 'advance directive', or a 'living will'). means a statement explaining what medical treatment the individual would not want in the future, should that individual 'lack capacity' as defined by the Mental Capacity Act 2005.

It can relate to all future treatment, not just that which may be immediately life-saving.

An advance decision is legally binding in England and Wales. Except in the case where the individual decides to refuse life-saving treatment, it does not have to be written down, although most are and a written document is less likely to be challenged.

Carers and relatives

If the person you care for is aged 18 or older and has mental capacity they can appoint a personal welfare lasting power of attorney (LPA). The person who is given power of attorney (the 'attorney') will be able to make decisions about future medical treatment on their behalf if the person doesn't have the mental capacity to make the decision.

If the person you care for wishes to refuse medical treatment in the future, they should make their wishes known by making an 'advance decision'. This is made when the person still has capacity and is used if they're not able to make the decision themselves at the time of the proposed medical treatment.

If the person you're looking after makes an advance decision, you can't override it unless the LPA was made later and specifies that you have the power to do so.

What should be in an advance decision?

The code of practice in the Mental Capacity Act provides a checklist of information to be included in any written statement. The statement should include:

  • Full details of the person who is making the statement, including their date of birth, home address and any distinguishing features (so that an unconscious person, for example, could be identified).
  • The name and address of their general practitioner (GP).
  • Whether the GP has a copy of the statement.
  • Something to say that the decision is intended to have effect if the person lacks the capacity to make treatment decisions.
  • A clear statement of the decision, specifying the treatment to be refused and the circumstances in which the decision should be used or which will trigger a particular course of action.
  • The date the document was written and, if appropriate, the date it was reviewed.
  • The person’s signature. If the person can't write, they must give authority to somebody else to sign on their behalf in their presence.
  • A signature from a witness to the above (You may wish to seek legal advice about this)

For more information

 

Shared decision making (SDM) is the conversation that happens between a patient and their health professional to reach a healthcare choice together. This conversation needs patients and professionals to understand what is important to the other person when choosing a treatment.

Patient Decision Aids are specially designed information resources that help people make decisions about difficult healthcare options. They will help you to think about why one option is better for you than another. Find out more on the website

They include:

If you require any information about our policies please contact:

Freedom of Information
Ashbourne Centre
Kingsway Site
Derby DE22 3LZ
or email:
foienquiries@derbyshcft.nhs.uk

The way we record will depend on your needs and what works best for you – these are some examples we might use:

Aims or Goals form G

Sign care plan

Staying Well form

Care Plan and Review form C

ITEP work sheets

TOP

Accessible documentation for people with Learning Disabilities (not yet available electronically but could include CPA care plan, person centred tools, stay well plan)

FACE Mental Capacity Assessment

FACE Mental Capacity Assessment Guidance

CPA Standards and Update (CPA level 1)

Care Coordinators Underpinning Knowledge (level 2)

Safeguarding

Equality and Diversity

Think Family

Impact of parental mental health

WRAP approach (Wellness Recovery Action Planning)

Substance specific bite size training – ITEP

Person centred training courses

Sign and Symbol Training

Person Centred Care (see SCIP)

 

Care Quality Commission Essential Standards for Quality and Safety - Outcome 1 Respecting and Involving people who use services, and Outcome 2 Consent to Treatment

NHS Choices aims to give you information to help you choose the right service or treatment for you

The Trusts Medicines Choices information 

NICE gives information options

Rights 4me is the official website of the Office for the Director of Children's Rights

Infolink Resource booklet gives information about physical and mental health resources

Direct Payments: advice on DirectGov

Personalisation and Self Directed Support: Information about the:

Derby City Council approach and the

Derbyshire County Council approach

Medicines Choices: giving you guidance about medication, including side effects and benefits

The Methadone Alliance

NICE guidance (National Institute for Health and Clinical Excellence)

Substance misuse for primary care  

Drug Misuse and Dependence: UK Guidelines on clinical management (orange guidelines)

National Treatment Agency for substance misuse

Derbyshire Advocacy Service

Derbyshire Appropriate Adult Service

Derbyshire Independent Mental Capacity Advocacy Service (IMCA)

Values exchange: tell us what you think

Helen Sanderson Associates: Person-Centred Thinking and planning

Mental Health Act Code of Practice 2008

Service User Experience in Adult Mental Health: Improving the experience of care - A NICE Guide

National Survivor User Network (NSUN)

National Survivor User Network (NSUN) Newsletters

Self-care Connect is a pioneering and dynamic new resource and networking organisation for everyone with a professional interest in self care. The content is driven by users...

The Quality of Health Principles from Changing our Lives, an organisation that works for people with disabilities 

Self Help therapies

Person-centred care fron the Health Foundation

Action for Advocacy includes a database of advocacy services

INVOLVE is a national advisory group that supports greater public involvement in NHS, public health and social care research. INVOLVE is funded by and part of the National Institute of Health Research (NIHR).

Derbyshire Link - giving people a chance to say what they think about health and social care

Making ourselves heard network for young disabled people

No Assumptions: A Narrative for personalised, coordinated care and support in mental health from Think Personal, Act Local