How social workers are helping other professionals understand mental capacity

An NHS body has enlisted two social workers and an advocate to spread awareness of the MCA among fellow professionals and the public. One of the social workers, Stef Lunn, explains how they do it

Photo: Gary Brigden

What is the project all about?

Lots of people who should know about mental capacity issues don’t have the information they need. This is the same for members of the public as well as health and social care professionals. It’s a well-recognised fact, so we work towards addressing that problem, using every opportunity we find.

How is the work funded?

NHS England made special, time-limited, funding available to clinical commissioning groups (CCGs), which replaced primary care trusts in 2012. The CCGs covering Birmingham, Sandwell and Solihull decided not to spend the money on a straightforward training initiative, but to do something a little bit different.

How did two social workers and an advocate end up working for an NHS CCG?

The CCGs employed three people from outside the health service to work on this innovative project to raise awareness and confidence with the MCA. Martin Watson was previously working as an independent mental capacity advocate (IMCA); Michelle Moore came from her role as a hospital social worker and best interests assessor; and I have been working in social work education at the University of Warwick. One thing we all have in common is our drive to share the rights-based strengths of the legislation with others, from all walks of life.

How do you operate?

Whether we’re engaging with GPs, support workers in residential environments, citizens attending public events, dentists, housing officers or people sitting in their own living rooms (through our local TV advert) we try, wherever possible, to put the audience first, recognise their successes and offer something that is a bit different to engage with people and hopefully encourage them to remember the session.

What do you do?

We use case studies and case law to bring learning to life. We look at how the MCA features in their day-to-day practice which helps us work with them to build solutions to some of the tricky issues they are grappling with on a daily basis. We begin by building people’s confidence in what they already know and what they’re already getting right about the MCA. Often, people who feel that they know very little about the act are already following the principles through good person-centred, rights-focused care.

We try to make all our learning experiences a bit more dynamic than the norm, and encourage people to examine their own preferences and unwise choices. When we hear laughter and sharing of experiences, we know that we are on the right track to breaking down some of those heavily entrenched divisions and hierarchies between professions.

Have you got some examples of how you work?

These case scenarios examine the realities of assessing capacity and best interests decision making for a GP. We present a scenario with all the relevant information for discussion and then have questions at the end looking at the options available, what should happen next or what the professional should do.

Do you have a success story you can share with us?

The service featured in these videos had very little confidence in the MCA when we first started working with them – but as you can see, they are committed to working hard towards the principles of the MCA, and are making some great progress.

What are the challenges?

There have been times when we’ve needed to challenge practices which are at odds with the act. But we have found that most services are keen to improve and are more able to do so if they don’t feel the need to be defensive. Of course, this needs to be sensitively balanced with the difficult issues which are often part and parcel of decision making.

Through listening to this knowledge, we have built up a good understanding of the ways that MCA interfaces with other issues in practice – which means we can make sure we’re engaging with relevant topics that staff understand.

We have encountered lots of different cultures within different part of the NHS, and being sensitive to the needs of each group – but most of all remaining human and understanding – has really helped. We’re grateful to those people we have met along the way including local councillors and those working in hospitals, hospices, community safety partnerships, community organisations, and even the fire service, who are spreading the word energetically among their own networks. I should also remember to thank our manager who made the case for this exciting project and had faith in us, despite our slightly unorthodox approaches!

Where can we see some of the project’s other work?

You’ll find more information here on our web pages.

Stef Lunn is the project manager for the MCA project for NHS Birmingham South and Central CCG

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