Over the past few months I am starting to reflect on the manta of choice whilst being an advocate for a disabled person with mental health issues. This will be a two part blog about issues around choice. Part one reflects on definitions of choice in the area of options and solutions available for disabled people using public services. The second part will reflect on Personal Assistants role in promoting disabled person’s choice.
Choice has various definitions that cover various selections of options that we are able to choose from.
Elite Choice – the best possible option
For some lucky people, a choice has meant the careful selection of options or solutions that provides the best outcomes for the individual concerned. Individuals will have all the personal, economic or social resources to either create options by commissioning personalised solutions or being able to source existing options that meet their needs. For instance I know a quite wealthy senior couple who wanted to down size from a big family home to a smaller flat whilst having the potential to access on-site care services. The couple approached a housing association to ask if they would be prepared to offer a plot of land on a long-lease agreement so they could build a flat to their personal specification and therefore creating a solution in lieu of unsatisfactory options within the borough.
Careful Selected Choice between options
Of course many of us do not have complete choice; however, the range of available options will be dependent on our social-economic status, the type and nature of the choice being made and market demand. By illustration I will use counselling services – if wealthy, one is able to choose between private and NHS run counselling services, counsellor’s specialism (i.e. dialectical behavioural therapy, cognitive behavioural therapy, psychotherapy and psychoanalysis therapy) and who will provide the one-to-one counselling service at the time of need. However, for many disabled people reliant on welfare benefits, the choice and timing of counselling services will not be possible.
Choice from a selection from a range of options
For many disabled people reliant on state-funded services, choice can often mean choosing between options and solutions that the state is willing to pay for. Choice can be restricted by eligibility criteria, budgets and availability of services increasingly being made available by the market through the private and third sector. For instance, access to publicly-funded housing can mean only viewing a couple of properties and turning them down before being placed at the bottom of the waiting list. Recently, the person I advocated for thought she may have the opportunity to consider two properties – but it ended up being a single property in an area that she knew little about and had to make that decision within a week.
Too often disabled person is given fewer options and solutions than their non-disabled counterparts. Day-time Activities, Employment opportunities and support arrangements are amongst a range of options that disabled people are offered usually beginning from what the agency can provide and arrange, rather than what can be sourced from out in the wider community. In some cases, the disabled person is prevented from using other agencies to maximise their chances of meeting an outcome. For instance a disabled friend of mine used a couple of disability charities to help her find employment. One of the disability charities told her that she must only use one agency because the funding comes from the Job Centre. However, during my employment search, I signed up to a number of employment agencies with the aim of maximising my chance for securing paid work. Too often disabled person is given fewer options than their non-disabled counterparts. Very few disabled people have the opportunity to create a solution in absence of any satisfactory options as part of their choice making process.
Informed Choice of selecting an option
Too often little thought is given to whether disabled individuals are making an informed choice; too often the focus is on the choice itself rather than the factors that enable a choice to be properly informed including consideration of relevant factors such as strengths and weaknesses of one or more options. Informed choices involves disabled person having enough time to consider relevant factors associated with selecting from one or more options which will satisfy their needs. Too often disabled individuals choices can be informed by their past experiences of success or lack of success in selecting from options or suggesting solutions that will meet their needs. Further, disabled people have limited opportunity to consider solutions that would make existing options more satisfactory ones.
No choice – no satisfactory option
Too often, disabled people are forced into making a choice, even if that is between equally bad options. Rejecting option(s) often leave disabled individuals without any service full stop and destitute. For many people having nothing can be worse than living with the bad option after careful consideration. And therefore is there recognition in reality a disabled person does not have a choice as the option to say no is actually in practice not a choice.
When we are considering choice, it is worthwhile reflecting on whether a disabled person is making a real choice, or whether the availability of options and solutions are ones that facilitate a real or no choice whatsoever. A real choice can only be made if there are the possibilities for the creation or the existence of options and solutions that will enable the disabled person to achieve their goals or deal with a problem in a positive manner.