Seven myths about the decision-making capacity of people with mental health problems
The United Nations Convention on the Rights of Persons with Disabilities states in its article 12 that everyone has the right to legal capacity , regardless of their decision-making abilities and their needs for support. That is, everyone has the right to make their own decisions, to have them respected by others, and to have them recognized by the law as valid.
"Legal capacity" is the right to have rights and obligations, and also the right to exercise (access and enjoy) these rights. Thus, we can understand that it is the right that allows us to enjoy the rest of the rights. On the other hand, "competence" refers to the person's abilities or capacity to make decisions.
It is true that there are some times when making decisions is more difficult (for example, in a crisis situation), but even in these situations it must be guaranteed that the person's rights are not restricted , offering them the support and guarantees they may need.
But sometimes people are denied their right to legal capacity and to be able to decide. Why? Often because we have misconceptions about their capacity to make decisions ; false beliefs that often lead to violating the rights of these people and fueling the stigma they have to endure because of having a disability or mental health disorder.
Let's dispel some myths that are widespread about the decision-making capacity of people with mental health problems or disabilities.
1. People with disabilities or mental health problems make bad decisions.
FALSE. This statement is not valid, since it is also not true in the opposite case: people without disabilities or without mental health problems always make good decisions. What is a good or bad decision depends on the opinion of each person, and we may not agree with it, but we cannot prevent them from making it, even when that decision may have negative consequences. And this would be valid for all people, whether they have a mental health problem or not.
2. People with disabilities or mental health problems have distorted ideas about reality.
FALSE. Having unusual, unique or different ideas about reality and life does not mean that the person (with or without a mental health problem) does not have the capacity to make decisions in their daily lives. Although we may think it is a wrong decision and we may be concerned about the possible consequences that may arise from it, we must respect their choice, independence and responsibility for the decisions and actions that each person takes.
3. People with disabilities or mental health problems should not decide about their treatment.
FALSE. Each person knows their body, mind, and daily life and, based on this, has preferences about treatment and care options. These preferences also differ from person to person, and are just as valid as the decisions and preferences of others.
The right to decide in the context of mental health
4. People with disabilities or mental health problems don't know what suits them best.
FALSE. Just like everyone else, people with mental health problems know what they like and don't like, and what works well for them and what doesn't. They also have the right to make mistakes: we all learn through experience.
5. People with disabilities or mental health problems are not capable of making decisions.
FALSE . This ability to make decisions in all areas of life is not a quality that is either possessed or not, but can vary throughout different moments of life, depending on the context and the decision that needs to be made. There will be times when it will be easier than others to make decisions, and sometimes support may also be needed to make them. This does not mean that, in general, people with disabilities are not capable of making decisions.
6. People with disabilities or mental health problems are afraid to make decisions for themselves, and they have to be told what to do.
FALSE. Some people have lost confidence in their decisions, probably due to negative perceptions of the reactions of those around them, and they shift the responsibility for making decisions to other people close to them (for example, family). These people should be supported to make decisions and regain confidence in their abilities to do so, instead of denying them the opportunity to decide.
7. Family members, caregivers and professionals are the ones who know best what is best for people with disabilities or mental health problems.
FALSE. Carers and family members of people with mental health problems provide invaluable support, but sometimes, acting according to what they consider to be best for the person, they can exclude them from the decisions they make. The same sometimes happens with professionals (healthcare and other disciplines) who, based on their technical knowledge and professional practices, sometimes also make decisions for the other person. In both cases, whether they do not see the person as someone capable of making decisions or whether they want to protect them, they must take into account that people with disabilities or mental health problems are capable of making decisions.
People with disabilities or mental health problems have the right and are capable of making decisions, even in difficult situations. We must trust their decision-making capacity and decisions, respect them and, if they need it, offer and provide them with the necessary supports so that they can exercise their right to make decisions.
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