Supported decision-making
Making informed decisions for ourselves instead of someone else making them for us is a human right, not a privilege. All of us get support from different sources to help us make decisions.
Supported decision-making is an approach that enables people to make their own informed decisions by providing the support they need to understand information, consider options, and communicate their choices.
It focuses on offering practical support which respects what the person wants, what matters to them and the choices they make.
This approach increases the voice, agency, choice and control of people with learning disabilities. It levels the playing field by giving them what they need to make informed decisions. By doing this, we challenge assumptions about ability and ensure that decisions reflect the person’s own views.
With the right support people with learning disabilities can be at the centre of their decision-making and experience increased voice, agency, choice, and control.
What do we mean by ‘informed decisions’?
Informed decisions are choices that are made with a clear understanding of facts, risks, benefits and potential outcomes associated with the options available.
Supported decision-making is about giving people the information they need to make good decisions. Crucially though, we must recognise that with all the information in the world, other people will still make what we think are ‘bad decisions’.
We all have the right to take control of our own lives by making our own decisions. Even if those decisions appear to be risky, our choices should be respected and supported, for example when a woman chooses to return to an abusive partner.
Protecting women’s right to make their own choices is important because it:
- Gives women the autonomy to make choices about their lives, and improves their self-esteem and general wellbeing.
- Enhances quality of life. For example, choosing to engage in life-enhancing social activities even when this carries a risk.
- Aligns with the principles of person-centred support because the preferences of women are prioritised.
- Recognises the danger of removing someone’s autonomy in order to live a risk-free life.
“Making our own decisions is good for our wellbeing, confidence, and learning. It allows us to practice making our own decisions, take responsibility and learn from our mistakes.”
– Member of People First (Scotland)’s Equally Safe Group, 2024
You can find out more about risk enablement here.
Trauma, coercive control and learning disability
Women with learning disabilities commonly experience multiple traumas, including gender-based violence, throughout their lives.
Women with learning disabilities also frequently have their right to make their own decisions taken away from them, particularly when they have experienced gender-based violence. This loss of control over their lives can lead to additional trauma.
It is therefore essential to understand the effects of trauma and coercive control when supporting women with learning disabilities, who are also victim/survivors of gender-based violence, to avoid repeating these patterns and causing additional trauma.
Effects of trauma from gender-based violence
Trauma from gender-based violence can have immediate and long-term effects on our ability to make decisions.
Short term effects include:
- Emotional changes: trauma often causes feelings of fear, guilt, shame and anxiety, that cloud our judgement and affect our ability to make decisions, resulting in choices that do not reflect our real needs or preferences.
- Cognitive changes: trauma can overwhelm us, making it difficult for us to focus on decisions.
Long term effects include:
- Ability to assess risk: significant trauma, particularly in childhood, can affect our ability to weigh up risks and consequences.
- Changes in the brain: trauma can lead to changes in the areas of the brain that are responsible for memory and decision-making that can result in impulsive behaviour and difficulty in processing information. Trauma can also cause us to focus on potential risks and dangers that can make it difficult for us to make balanced choices.
Effects of coercive control
Coercive control is a pattern of behaviour that is intended to increase perpetrators’ power and control over victims by isolating them and removing their independence and choices. Perpetrators do this by isolating them from support, manipulating and exploiting them, depriving them of their independence and controlling their everyday behaviour.
The effects of coercive control extend beyond victim/survivors’ relationship with their abuser, impacting them long after they have left their abuser.
The long-term effects of this often leaves victim/survivors struggling with the smallest of decisions. Dependency on their abuser, anxiety and confusion, loss of autonomy, self-esteem and psychological manipulation can have a significant effect on their ability to make future decisions.
Activity 3
Purpose: The purpose of this activity is to improve understanding of supported decision-making, and the effects of this on victim/survivors with learning disabilities.
Read the following statements and choose whether you think they are true or false.
Supporting women with learning disabilities to make informed decisions can aid their recovery from gender-based violence.
True: By promoting a culture of supported decision-making, you can support victim/survivors with learning disabilities to navigate uncertainty, as well as empowering them to achieve better outcomes for themselves, such as:
- Increased confidence
- Greater control
- More options
- More realistic expectations
- Achieving their desired goals
- Minimising risk
Specialist support is needed to assist women with learning disabilities to make decisions.
False: When support is offered in the context of trusting relationships, there are a number of things we can all do to support women to make their own decisions. These steps are:
- Clearly identify the issue.
- Collect relevant information.
- Compare the options by considering the potential risks, benefits and short and long-term outcomes of each option.
- Make a decision.
- Implement the decision.
- Review the decision.
This is not a checklist or box-ticking exercise. The process of supporting someone to make their own decisions should take place within the context of a trusting relationship, and perhaps over a number of conversations.
Advocacy services can support women to make informed choices.
True: Advocacy services can play a crucial role in promoting autonomy by supporting women with learning disabilities to make their own decisions.
Advocacy services may include communication aids, support from professional advocates, and tailored communication strategies to help victim/survivors make their own choices and communicate their decisions.
