‘A best interest meeting’ – what it is and how it works
This article discusses what a best interest meeting is and how it works. To do this, it considers the concepts ‘capacity’, ‘deprivation of liberty’ and ‘best interests’. People with mental illness or learning disability may have mental capacity to make decisions about their lives including where they live and how they want to live. In some cases, people lack the capacity to consent to particular treatment or care that is recognised by others as being in their best interests, or which will protect them from harm. When this care might involve depriving vulnerable people of their liberty (i.e. taking their freedom away) in either a hospital or a care home, extra safeguards have been introduced in law to protect their rights and ensure that the care or treatment they receive is in their best interests. A decision made, on behalf of a person who lacks capacity, must be done or made in that person’s best interests. Any decision made on behalf of the Patient must be made, or done, in the best interests of the patient. A Patient is someone determined to lack capacity. A best interest decision cannot be made for a service user if they have been assessed as having capacity to make the decision or (where there is doubt about capacity) a capacity assessment has not been undertaken to confirm that they lack capacity.
What a best interest meeting is and how it works
* A best interest meeting may be needed where an adult (16+) lacks mental capacity to make significant decisions for themselves and needs others to make those decisions on their behalf.
* A formal best interest meeting is likely to be required where the decisions facing the service user are complex and cannot easily be made by the decision-maker and immediate colleagues.
* A best interest meeting or assessment is a consideration as to whether it is in the best interests of the person to have a deprivation of liberty. If it is decided that it is in the best interests of the person, then authorisation can proceed. In England and Wales the assessments must be undertaken by an AMHP (“Approved Mental Health Practitioner”), social worker, nurse, occupational therapist or psychologist with specific skills and experience.
* It is generally best practice that the person who chairs or co-ordinates the best interests’ meeting is not the decision maker. It would usually be expected that a Principal Practitioner or General Manager will chair the best interests meeting or a registered and experienced health or social care professional.
* To support service users, their family members and/or representatives in feeling as comfortable as possible on the day of the meeting, it is good practice for the chair to arrange to meet, (with those identified above) at the venue approximately 20 minutes before the meeting is due to commence.
* The best interest meeting involves introductions and apologies, a purpose of the best interest meeting, view of the relevant person, information from relevant parties, discussion of viewpoints and summary and evaluation of options, decision of the meeting about the person’s best interests, an action plan, a communication strategy and any other business. The view of the relevant person includes what is known about the person’s past wishes, feelings, present wishes and feelings, any relevant written statement made by the person when they had capacity and their beliefs and values. The discussion of viewpoints includes identifying and being clear about the options, discussing the benefits and advantages of each option and assessing the likelihood of each option.
The Court of Protection is a court specifically set up to deal with issues relating to people who cannot make decisions for themselves because they lack the capacity to do so. Many decisions can be made without resorting to the Court of Protection. If there is a disagreement, the Court of Protection will be asked to make a single decision on behalf of the group of people. The Court of Protection has the role of arbiter when things go wrong.
A deputy is someone appointed by the court who is authorised to make decisions for a person who lacks the mental capacity to do so themselves. A deputy usually makes decisions about finances and property. The court can appoint a deputy to take healthcare and personal care decisions, though this is relatively rare. In the majority of cases, the deputy is likely to be a family member or someone who knows the person well but in some cases the court may decide to appoint a deputy who is independent of the family (for example, where the person’s affairs or care needs are particularly complicated). Best interest decisions differ from deputyships, as deputyships are a group of decisions and a best interest decision is an individual decision.