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My Decision Still

Sandie Cox, Adult Safeguarding Lead, Hounslow and Richmond Community Healthcare NHS Trust

Using the Mental Capacity Act in the Community

As an adult social worker joining the NHS in 2016, I did not imagine that within a year, I would be producing a short training film that in 2018 is being used across England and Wales by hundreds of health and social care staff, paid and family carers and even Ministry of Defence Welfare Officers.

I am an Australian Londoner and ex-teacher with many years’ experience in social work; across both the voluntary sector and local authority. In my day job as the Adult Safeguarding and Mental Capacity Professional Lead for an NHS Community Trust in West London, I advise, train, write policy, and assure the Trust that our 1000 plus staff are working in ways that support adults at risk and are compliant with relevant law and guidance.

As a passionate and vocal member of the National Mental Capacity Forum, I knew that although the Mental Capacity Act was over 10 years old, its principles are not consistently embedded in healthcare practice.

I found that when I said “Mental” and “Assessment” in the same sentence to many health staff, they retreated quivering behind the comfort blanket of the medical model, hoping that such an assessment would be a task for a ‘specialist’.

Not so! Assessing mental capacity where we have concerns about the impact of a mental disorder or disturbance on decision making is everybody’s responsibility and the Mental Capacity Act guides us to support people in a fair and person-centred way.

I needed a way of breaking down the nervousness which was impacting on practice and recording. I knew that a multimedia approach would appeal to a broad range of people with different backgrounds and ways of learning. I then needed the money to make my dream a reality. I pitched my idea to our Trust’s ‘Dragon’s Den’ programme and won.

Since I knew nothing about film, I consulted Dr Google, and invited tenders. Fortunately, I chose Loaded Productions. Working with the wonderful Angus Hubbard, I agonised over many versions of the script and in consultation with colleagues and carers, we agreed we needed actors for key roles.

Angus commissioned the amazing Tommy Jessop (of Blue Apple Theatre and Hamlet fame) for the role of Matt and the very experienced June Bailey for the role of Lynne.

I wanted to ensure the film was a practical ‘show how to know how’ guide using simple scenarios. It needed to be under 30 minutes long for viewing in a team meeting or a short break from caring.  It had to be freely available for sharing widely and the wording had to be both realistic and positive (I used some tried and tested NLP principles). We also created a booklet to accompany the film, aimed at those who do not have internet access.

The film has now been shared locally and nationally and has been widely used to support learning and to raise awareness of the legal requirement to uphold the human rights of people with a disorder or disturbance of their mind or brain, when offering and recording care.

It was nominated for the National Learning Disability and Autism Awards 2018 and has received consistently positive feedback from all over England and Wales from Safeguarding Adult Board members, social care and health staff and trainers and carer’s organisations.

The film is available to view on the HRCH Youtube channel.





Edel Harris





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