Psychologists' perspectives on supported decision making in Ireland

Abstract

Background A new legal capacity act was introduced in Ireland in 2015. This study aimed to identify and critically examine key issues in the area of decisionmaking capacity from the perspective of psychologists working with adults with an intellectual disability. Methods A qualitative exploratory approach was employed, and the study was positioned in a social constructionist framework. Purposive and snowballing sampling methods were used to recruit 15 clinical psychologists working with adults with an intellectual disability. Data were collected with the use of individual semistructured interviews. Interview transcripts were analysed using a model of thematic analysis. Results Six themes were identified: (1) a presumption of capacity but a culture of incapacity, (2) supporting decision making as a process, (3) authenticity of decision making, (4) need for support and training, (5) contributions of psychology and (6) the way forward. Conclusions Participants described that people with intellectual disabilities were often excluded from decision-making processes. They welcomed the functional approach to decision making, considered substituted decision making to be necessary within a support framework and described supporting decision making as a process. Systemic, resource and attitudinal challenges were identified.

Israeli social workers’ recommendations on guardianship and supported decision-making: Examination of client and social worker factors.

“…Second, Israel has not yet fully implemented its SDM reform, thus we cannot fully infer on how this reform may have led to change in social worker judgments. Third, the role of potential risk, a crucial factor in guardianship decisions (Rogers et al, 2020), was not examined. Fourth, we did not investigate agreement to SDM and did not investigate how clients’ agreement played-out in relation to their family’s preference.…”

Between the convention and conventional practice: Israeli social workers' recommendations regarding the legal capacity of people with disabilities

“…In light of the scarce available research in the field, some helpful insights can also be gained from studies on other professionals such as psychologists, psychiatrists, occupational therapists, speech and language therapists, mainly in the context of the UK Mental Capacity Act, 2005. These show that professionals often face challenges in incorporating new legal capacity frameworks; have inaccurate understanding of legal capacity‐related practices, mainly SDM; assess mental capacity based on their clients' perceived best interests; raise concerns over misuse of SDM; are prone to risk aversive interventions; and struggle to provide their clients, particularly those with high communications needs, with adequate support and accommodations (Gooding, 2015 ; Jayes et al, 2020 ; Rogers et al, 2020 ).…”

The experiences of psychologists working with people with intellectual disabilities during the COVID‐19 crisis

“…In recent decades, long‐term care for people with intellectual disabilities has been provided by support staff within an integrated setting in the community, in order to address the specific needs and desires of these service users. Support staff often work alongside psychologists who specialise in caring for people with intellectual disabilities (Rogers et al, 2020 ). A significant part of psychologists' workload in these settings is dedicated to implementing psychological and behavioural interventions (Stenfert Kroese & Smith, 2018 ).…”