Supported decision-making

Also called SDM, Supported decision making, Decision support

The practical work of helping a person make their own decision: the right information, in the right form, at the right time, with the right person.

What it is

Supported decision-making is everything you do so that a person can make a decision themselves rather than have it made for them. It is the second principle of the Mental Capacity Act turned into a method, and it is also what Article 12 of the UN Convention on the Rights of Persons with Disabilities asks every country to provide.

It is not the same as best interests. Best interests is what happens after support has failed. Supported decision-making is the attempt, and it must come first.

Who it can help

Anyone facing a decision who needs help to understand it, think about it or express it. That is a wide group: a person with a learning disability deciding where to live, a person with aphasia consenting to treatment, an autistic teenager choosing a college, a person with early dementia making a will.

It is not a way of steering someone to the answer you prefer. If the support only ever produces the decision the supporter wanted, it was persuasion, and a court will see it that way.

How it works

Four things, in this order. Information: strip the decision to what actually matters and present it in the person's format, which might be easy read, photographs, a Talking Mat, a video, or a visit to the place being decided about. Time: give the person days, not minutes, and come back more than once. Environment: the right room, the right time of day, no pain, no hunger, no audience. People: someone the person trusts who knows how they communicate, and who is not the person with a stake in the outcome.

Then the decision itself is expressed in whatever mode the person has, and the supporter's job is to record it faithfully, including the reasons if there are any. An unwise decision is still a decision. The Act says so in section 1(4).

Getting started

Pick one decision coming up for the person you support and plan it. Write the options as two or three short cards with a picture each. Decide when you will introduce it, when you will come back, and who will be in the room. Put the choice board or Talking Mat together before the day.

On the day, ask open questions first and give real wait time. Offer the choice in the person's own mode: pointing, signing, eye gaze, a talking board. Record what they chose and how they showed it. If the answer is unclear, that is a reason to try again differently, not a reason to conclude they cannot decide.

Keep the record. A written trail of what was tried is the single most persuasive thing you can show a professional who later claims the person "cannot decide".

Where to get help

SCIE has practical guides on supporting decisions. Mencap and BILD run training. An independent advocate is often the right person to support a big decision, because they have no stake in it, and for some decisions the law requires one: see IMCA and Care Act advocacy.