# Support for decision-making guidance in England: a pragmatic review

## TL;DR

This paper reviews how decision-making support is understood and implemented in England, highlighting legal and practical challenges.

## Contribution

The study identifies gaps and inconsistencies in SFDM guidance and proposes a more multifaceted approach aligned with international standards.

## Key findings

- Current SFDM guidance in England lacks multifaceted advice for different decision types and supporter roles.
- There is a dualistic model of SFDM due to diverging legal interpretations.
- Gaps exist in guidance for mental health contexts and third-party involvement.

## Abstract

Law and policy concerning personal decision-making increasingly recognizes a role for support to enable greater autonomy and legal recognition for adults whose decision-making ability may be limited. Support for decision making (SFDM) is embedded in England and Wales under the Mental Capacity Act 2005 (MCA). It has also gained traction internationally through the UN Convention on the Rights of Persons with Disabilities (CRPD), to which the UK is a signatory. However, these two legal reference points diverge in their understanding of SFDM, which presents challenges for putting it into practice. A pragmatic review methodology identified 40 resources containing SFDM guidance, providing insight into its implementation and conceptualization in England. An analysis indicates the need for authoritative guidance that provides more multifaceted advice, recognizing key variables including: the nature of the decision, source of decision-making difficulties, and the relationship of the supporter. Gaps in guidance provision are also identified for decision-makers, third parties, and the mental health context. The resources largely conceptualize SFDM as a means to enable mental capacity. However, recent developments propose a CRPD-aligned approach that includes SFDM in the context of substituted decisions. This generates a dualistic model of SFDM in England, raising new questions in this area.