Consumer Perspective: Theory and Practice

This article explores the concept of supported decision making (SDM) as a substitute for traditional guardianship in Australia. It discusses the principles that underpin SDM and how it can be applied to patients with mental problems using electroconvulsive therapy (ECT). The article also provides a personal reflection on the author's experience in supporting a patient with mental illness through the SDM process.

Running Head: CONSUMER PERSPECTIVE: THEORY AND PRACTICE
Consumer Perspective: Theory and Practice
Name
Institution

CONSUMER PERSPECTIVE: THEORY AND PRACTICE 2
Consumer Perspective: Theory and Practice
Introduction
Supported decision making (SDM) has been established in Australia as a substitute for
traditional guardianship. This has been attributed to the decreasing application of guardianship in
providing care to persons with disabilities to make decisions. Legislation like the Victorian
Guardianship and Administration Act (1986) has been criticized as having an element of
paternalism that does meet the definitions of the contemporary concepts of the rights of
individuals with diverse disabilities. SDM as a concept helps persons with disabilities to better
attain the rights of individuals with problems in the background of mental health law, as well as
policy transformation. The autonomy to make decisions regarding significant issues in a person’s
life is vital in promoting an individual’s ability to make better decisions independently. For
individuals with serious mental diseases, like bipolar disorder, schizophrenia, as well as main
depressive turmoil; nonetheless, the ability and ability to autonomously render proper social,
financial, along with medical choices may be restricted, partly by cognitive states (Martinis,
2015).
Consequently, the majority of these persons are put under complete/plenary legal
guardianship that happens when a substitute decisions maker is given the power to make all the
choices or preferences (other than definite ones connected to money or healthcare among others)
on behalf of another individual (Blanck & Martinis, 2015). Emerging studies concerning persons
with cognitive disabilities considers that plenary custody currently can be used too extensively
and can have likely damaging impacts, like decreased self-respect, decreased apparent self-

CONSUMER PERSPECTIVE: THEORY AND PRACTICE 3
efficacy, behavioural compliance, as well as the likelihood to abuse the privilege by selected
guardians (Blanck & Martinis, 2015). Support decision making will function effectively on
patients with mental problems using electroconvulsive therapy (ECT) in an effort to make better
decisions towards improving the condition and quality of life.
The present paper will examine the background and principles that underpin the
supported decision making approach and explore how supported decision-making will be helpful
to the patient with mental problems using electroconvulsive therapy (ECT). This will be the
reflection of my own experience in supporting the patient that had mental disease using ECT
while working in my past workplace.
Background
SDM has been established in Australia as a substitute for conventional adult custody in
the background of mounting recognition, which guardianship law is outmoded. According to
Blanck and Martinis (2015), SDM entails an attempt to offer less limiting alternatives to
guardianship along with alternative decision-making that will support the autonomy of a person
with a cognitive disability (Blanck &Martinis, 2015). At the centre of the SDM is the
acknowledgment that persons with mental problems can need a greater degree of support to
make informed decisions in their lives. This will ensure that they have the right to this kind of
support. This support model is perceived as a place where an individual with mental problems
remains the decisive decision-maker. However, recruits family, peers, as well as other trusted
individuals, to assist illuminate the issues at hand, the alternatives obtainable plus when required,
interpret in addition to communicate her/his will along with choices to other people. Whilst

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people with mental problems can require higher support in making important decisions, the use
of support to undertake these choices is somehow the same as the distinctive decision-making
course amongst many adults. This is where discussion with trusted associates on important life
choices is universal (Kohn, Blumenthal & Campbell, 2013). Though support decision-making
sufficiently matches the daily decision-making process, the present legal model normally
acknowledges only the person/singlehandedly decision-maker. This will ascertain
competence/ineptitude, devoid of provisions for supported decision making as a substitute to
guardianship (Powers et al., 2012).
Moreover, supported decision making is defined as a practice of supporting individuals
with their decision making, coordination, which affords legal status and a way of bringing an
individual’s will plus preference to the focus of any substituted decision making procedure. This
process allows some individuals to exercise their legal capability, and consequently higher self-
determination and freedom (Gooding, 2012). The SDM has been thought to be a conceptual, as
well as practical bridge that allows better attaining the rights of individuals with disabilities in
the background of mental wellbeing legislative plus policy transformation. Gooding (2012)
asserts that supported decision making is a means in which persons with mental impairment may
be supported to manage own monetary packages, plus individualized support. SDM has been
found to be a development of supporting an individual with their decision-making. Hence, this is
an alternative legal rule to substituted decision-making and a system designed to substitute
guardianship. This implies that SDM is an ingredient of a novel lawful model for safeguarding
self-determination, the right to lawful capability (Bach & Kerzner, 2010), plus a framework,
which accommodates shortfalls in decision-making capacities, especially among individuals with

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serious mental illness. Hence, SDM is both a development plus an end that officially
acknowledges the process of SDM and the legal position of choices realized as part of this
procedure (McSherry, 2012).
The principles that underpin SDM are that it is borne of the social framework of
disability, where the “problem” is not the individual with mental problems or disability. But in
societies that fashion diverse barriers that hinder the full and efficient participation of individuals
with mental problems in the society on an equal basis with others. Thus, the SDM is founded on
the capacity that an individual will retain the full legal capacity (Roberts & Kim, 2016). This
implies that the supporters recognized by the legal model will help the individual to reach and
communicate his/her own choices. This will allow the person with mental disabilities to make
decisions because of the autonomy. Another principle is the element of trust that exists between
the person with mental problems and the supporter. The relationship is founded on the free
agreement that is possible through the trust that has been created between the person with the
disability and the supporter in a legal environment (Browning, Bigby & Douglas, 2014). This is
opposed to the guardianship system, which is founded on an association of paternalistic
subordination. In SDM, the primary duty of the supporter is to allow the supported individual to
make his/her decisions and on the premise of informed choice. Thus, supporters help the adult
with the mental disability to communicate his/her intentions to others plus assist him/her to
comprehend the choices available at the moment. This implies that the supporters are facilitators
of the supported individual’s decision-making process and they have the duty of respecting the
person’s preferences, as well as interests (Pathare & Shields, 2012).
Application

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Providing support to patients with mental illness can be challenging because one should
make decisions on behalf of the patient. Many patients have challenges in making decisions;
hence, need a supporter to make decisions on behalf of the patients. My experience involved
Henry 32 years-old who was my cousin that I assisted to provide supported decision-making
while I was working at ABC Hospital two months ago. Henry had developed mental problems
and he required supported decisions concerning receiving electroconvulsive therapy (ECT) when
he became mentally ill. Henry was unable to make decisions on using electroconvulsive therapy
that he needed to recover and manage his mental condition (Read & Bentall, 2010). ECT is
among of the most contentious treatments for mental diseases that make it hard to make
decisions around ECT and it will involve using supported decision making to allow the person to
make the decisions on whether to use ECT or not based on the information. This complexity was
a serious concern for Henry who needed the support in decision making to make informed
decisions and I believe I was the one that could provide this support to Henry in order to make
informed decisions (Walker &Bryant, 2013).
As a result, in order to provide supported decision making I had to seek legal counsel that
is among the principles of the SDM model. This practice allowed me to support Henry through
the entire process that would help him make informed choices and preferences. The legal aspect
ensured that I complied with the regulations needed so that the decisions that will be made by
Henry are legally binding. This ensured that there will be no legal issues that will arise afterward
after Henry making the decisions. Additionally, to promote effective SDM, I had the
responsibility of ensuring that I build trust between Henry and myself. This was important to
ensure that the relationship creates an environment that will ensure that Henry makes informed

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decisions. Trust is essential in ensuring that there is a mutual relationship that will promote better
decision-making process regarding the use of electroconvulsive therapy to promote the
management of mental health condition (Carney, 2012). The trust was essential in the condition
of Henry since ECT is a controversial therapy that needed one to have sufficient information
towards SDM. During my session with Henry, I provided many substitutes to his treatment and
management of his current condition. Supported decision making model is founded on providing
substitutes that will allow one to make decisions based on choices and preferences. Nonetheless,
in my case, I stressed on the alternative of ECT as an effective treatment method for mental
disease including depression. I believed that this was the only viable alternative that will help
Henry manage his mental condition (Harvey et al., 2013).
Therefore, in this scenario, I provided adequate information to Henry on the importance
of using ECT to manage his condition. I also convinced him that ECT is a safe treatment method
for mental problems, including depression. I had to take Henry to a calm and safe place in my
residential home where I encouraged him to share his concern regarding the ECT and what he
feels will the problem. Henry expressed concern about the safety of the therapy because of the
past narratives that he had heard from others. Because of the experience that I have on ECT, I
had to assure him that the therapy is safe and effectual in the treatment of mental problems that
he had developed. With my knowledge regarding ECT, I advised Henry that it is effective in up
to 85 per cent of individuals with serious mental illnesses. Additionally, ECT supports positive
outcomes faster as compared to medications or other interventions (Smith, Vogler, Zarrouf,
Sheaves & Jesse, 2009).

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In addition, I provided him with past experiences of many friends and relatives that had
used ECT and have reported positive outcomes and that he needs to seek ECT to improve his
current condition as it is still in its early stages. I had to give him many examples of many other
persons that had recovered from depression since they use ECT. This information was effective
in ensuring that he makes informed decisions through my support. Through the trust that I had
created at the start of the session towards promoting the supported decision making, it was clear
that Henry made the decision to use ECT to manage his condition. This was clear that Henry had
insufficient information and stereotypes regarding ECT and that his mental condition could not
allow him to make informed decisions and that he needed SDM. In this regard, Henry was able
to make informed decisions regarding his choice of ECT and this was due to the support that
allowed me to offer supported decision making assistance (Amazon, McNeely, Lehr &
Marquardt, 2009).
Reflection
In my view, I believe that SDM is an efficient model that will allow persons with mental
problems to be supported in making sound decisions. In the case of Henry, SDM was effective in
allowing Henry to make the best decisions on going for electroconvulsive therapy (ECT) that is
efficient in managing his condition. Supported decision making was instrumental in ensuring that
Henry had many alternatives that he could choose from and make the decisions on which
alternative was the appropriate one for his condition. This was primarily founded on the
information that I provided to him all through the session. In addition, Henry made the decision
to use ECT to treat his mental illness that was possible because using the principle of trust for

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SDM. I was able to create a favourable environment that allowed him to make sound decisions
regarding his health (Jameson et al., 2015).
Additionally, I was able to formalize the session of the supported decision making since
this was essential in ensuring that the rights of Henry are respected because of his current mental
state. Thus, I had to seek legal services to formalize support session as a supporter in providing
information towards making better decisions concerning his health. The formalizing of the
relationship was important to promote effective structure for effective communication in
exploring alternatives for the decision making. Eventually, through the principles of SDM
model, Henry was successful in making the decision to use ECT as a treatment plan to manage
his mental condition during the early stages (Palmer & Harmell, 2016). Whilst several persons
may find SDM arrangement to be sufficient, I suggest that before alternative decision-making is
invoked; an official SDM agreement must be considered as a least restrictive alternative.
Moreover, the challenge that I perceive to have prevailed in the supported decision
making model was the issue of converting principles into practice. The problem with the
principles of SDM is that except an obvious case law, there may be a noteworthy difference in
the translation of principles into the practice. The principles that underpin SDM in the case of
Henry in using ECT were a major challenge in putting them into practice because it needed many
efforts. This was true in the case where there is a need to safeguard the rights of the client
seeking help to make decisions. This implied that there is a need to invest in looking for more
information on how to successfully convert principles to practices to effective SDM (Werner &
Chabany, 2016).

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Conclusions
The SDM has the potential to significantly improve the health and quality of life for
individuals with serious mental ill health. Supported decision making is an effective model for
assisting individuals with mental problems to better make informed decisions concerning
finances and treatment plans that they need. These individuals with mental illnesses need a
supporter to empower them to make rational decisions to better improve their quality of life and
promote the management of their condition. Through the alternatives provided to these persons
with mental disabilities, they will be in a better position to make better choices that will
transform their lives like the case of Henry. To completely attain the goal of promoting
individual independence, execution of the supported decision making entail many core elements:
information is presented to the person (comprising possible substitutes); the person consults with
supporters as he/she prefers; the person reaches a choice; as well as the choice is documented,
executed in addition to lawfully enforced. This was the case of Henry that allowed him to make
the decisions to seek and use ECT (Cyrzyk, 2013).

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