Best Interests Decisions Study

Study Code / Acronym
BIDS
Award Number
023/0148
Programme
Policy Research Programme
Status / Stage
Completed
Dates
2 March 2024 -
16 October 2011
Duration (calculated)
12 years 04 months
Funder(s)
NIHR
Funding Amount
£213,531.51
Funder/Grant study page
NIHR
Contracted Centre
University of Bristol
Contracted Centre Webpage
Principal Investigator
Professor Valerie Williams
PI Contact
Val.Williams@bristol.ac.uk
WHO Catergories
Legislative and regulatory environments
Disease Type
Dementia (Unspecified)

CPEC Review Info
Reference ID186
ResearcherReside Team
Published12/06/2023

Data

Study Code / AcronymBIDS
Award Number023/0148
Status / StageCompleted
Start Date20240302
End Date20111016
Duration (calculated) 12 years 04 months
Funder/Grant study pageNIHR
Contracted CentreUniversity of Bristol
Contracted Centre Webpage
Funding Amount£213,531.51

Abstract

The 2005 Mental Capacity Act (MCA) 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. Research about best interests decisions since the Act however has highlighted confusions in practice (Myron et al, 2008), concerns about tokenism (Donnelly, 2009) and challenges relating to the resolution of conflicts (Joyce, 2007). There are still several unanswered questions about how the best interests principle impacts on the experience of those lacking capacity (Stanley and Manthorpe, 2008) and how it is interpreted in major life-threatening situations (Hegde et al., 2006). Our own research in this area has highlighted the need to deliver both robust and quantifiable knowledge of current practice, while also seeking better understandings of how best interests decisions are made. Thus the central aim is to deliver evidence about the extent to which the MCA and its guidance are effective. The objectives of the research are: a) to determine the extent and scope of best interests decision making, in relation to different contexts and different groups of individuals who may lack capacity; b) to analyse different models of practice in determining best interests; c) to discover the factors taken into account in best interests decisions; d) to analyse what elements lead to ‘effective practice’, and also what obstacles are hindering progress of the MCA. Plan of Investigation 1. PREPARATION An existing audit tool will be developed as an online survey, in order to incorporate a module on best interests decisions. Concurrently, 6 focus groups will be held with people directly affected by the Act, in order to understand effectiveness and inform questions in the following stages. 2. PRACTICE SURVEY Over 4 geographical sites, we will aim for 400 returns of the online survey of people who have carried out best interests decisions; we will also carry out 100 telephone interviews. These will cover the 4 main groups affected by the Act and the 3 key decision areas. 3. UNDERSTANDING 20-30 cases will be followed up by semi-structured interviews, of 2-3 participants in each case; 4-8 cases will also be recruited for observation of ongoing best interests meetings. Potential Impact The impact of this research will be both on policy and practice. a) Evidence about the range and scope of models of best interests decision making will inform future guidance and support of the Act. b) The research will provide differentiated information about best interests decisions and capacity assessments for various groups of people who may lack capacity. There will thus be an impact on our knowledge of how to implement the Act in particular situations, and for particular groups. c) Impact on practice will be through an in-depth, practical understanding of good practice, the factors involved in best interests decisions, the range of models being followed, and current obstacles. This knowledge will be disseminated via extensive practice networks of all partners.

Aims

Our own research in this area has highlighted the need to deliver both robust and quantifiable knowledge of current practice, while also seeking better understandings of how best interests decisions are made. Thus the central aim is to deliver evidence about the extent to which the MCA and its guidance are effective. The objectives of the research are:a) to determine the extent and scope of best interests decision making, in relation to different contexts and different groups of individuals who may lack capacity;b) to analyse different models of practice in determining best interests;c) to discover the factors taken into account in best interests decisions;d) to analyse what elements lead to ‘effective practice’, and also what obstacles are hindering progress of the MCA.