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 is part two of a blog about issues around choice. Part one reflected on definitions of choice in the area of options and solutions available for disabled people using public services. This second part reflects on a Personal Assistant's role in promoting disabled person’s choice. Personal Assistants have always lived by the manta of promoting disabled person’s choice and control over their lives. A core aim of independent living is to ensure that disabled people have as far as possible the same control over their lives enjoyed by their non-disabled peers. So in the second part of this blog I will be looking at issues arising from a person’s choice and the dilemmas that some choices may pose to both Personal Care providers and Personal Assistants.
Assumptions about choice
There is quite rightly a presumption of disabled people making their own choices. After all I or others do not want our capacity to make choices questioned by anyone, family, friends, personal care providers or Personal Assistants.
Elite Choice – the best possible option
Sometimes Personal Assistants will respect the choices a disabled person makes. The consideration of alternative better choices does not necessarily require additional resources, but rather an opportunity to work with the disabled person to consider other options leading to better outcomes. I have been in various situations where I know a better choice would make situations less stressful for everyone concerned. Of course, the dilemma is for the Personal Assistant, who Am I to judge whether the disabled person has made the best choice from selected options – does the PA think about ideal or the best possible options for the disabled person to consider. On what if the best option is unavailable. After all many of us pick options or solutions far from ideal, but who decides whether selected options is good enough to achieve a satisfactory outcome for the disabled person.
Careful Selected Choice between options
For some disabled people their experience of choice is one on impulse; decisions are made there and then without careful consideration of the consequences. Recently I was trying to enable a person to make a careful considered choice about their new home and care arrangements. This involves asking my advocacy partner to highlight the good and poor points about their home and care arrangements and consider any solutions for making the placement as good as possible. The care staff involved was trying to persuade the disabled person that the placement was perfect. For Personal Assistants, to what extent should they be involved in enabling the disabled person to identify strengths, weaknesses and solutions associated with one or more options.
Choice from a selection from a range of options
None of us have every option available for us to make a considered choice. However, from my experience disabled people sometimes do not have a sufficient range of options to make a choice that will secure the desired outcome. An example is when a disabled person felt that the only option in lieu of not being able to afford a removal van bill is to sleep on the floor until they have sufficient benefits in place. At the time, the range of options were would not considered such as having a saving plan whilst in hospital, consider where she could save money (i.e. taking flasks rather buying coffees etc), others who could help and alike. No doubt if the disabled person was forced into considering the option of sleeping on the floor will affect her wellbeing and viability of discharge. This and other situations raise questions about availability of options and solutions which inform the choices we make in our day-to-day lives.
Informed Choice of selecting an option
Are we all always informed about the options and solutions presented to us when we make decisions? And to what extent should we be informed about the decisions we make. And if so what is the role of Personal Assistants to enable a disabled person to make an informed choice about an option or solution. Thus raising the question of whether a person’s choice should be taken on face value. On a placement visit I asked the question about choice and what would the care provider’s response be if a disabled person with mental health condition decided to leave their flat in an unacceptable messy state, full knowing that this environment may result in their emotional wellbeing deteriorating. The response was to respect the disabled person’s choice in a nutshell. If an unkempt flat is a sign of mental health deterioration then should a Personal Assistant make further inquiries and would the intervention be different – should the PA just leave the disabled person to it, live in a messy flat or should they be supported to clear it up. Alternately should the PA just get on with clearing up the flat with the intention of preventing the disabled person’s emotional wellbeing from further deterioration?
No choice – no satisfactory option
Too often the available options and solutions do not provide a choice that will promote the disabled person’s wellbeing. Sometimes, there is needs an acknowledgement that a disabled person cannot choose from a range of options and solutions that will satisfy their needs. When there is no choice, to what extent should the Personal Assistant be involved in enabling a person to make no choice that could make things worse. For instance, the local authority offered the patient I worked with options for shared living with other disabled people with learning difficulties and mental health conditions. S/He knew that accepting “group home” living would have a negative impact on their mental health and therefore offered no real choice of independent living on discharge from hospital. By refusing that option, there was every chance that the disabled person may not be offered an alternative placement. Family tried their best to persuade the disabled person to take up the shared living option in fear of getting nothing. The broader point is what role do the Personal Assistant has where the disabled person has no real choice – dammed if you do and damned if you do not.
The issues in these two blogs raises questions about the fundamental role of Personal Assistants and to what extent should they intervene to facilitate disabled person’s autonomy and what does choice mean in our day-to-day lives.