Choice


We have been taught and trained to regard choice and individuality, quite rightly, very highly. Choice is fundamental and giving people choice is a key task in developing strengths. Without allowing choice, we float around in a moral vacuum. Without choice we exercise power and control and continue to oppress those whom we should be working together with.

Giving choices isn’t always easy though. Certainly not as easy as it should be – especially when some (as is usually the case) of these choices have very concrete costs attached to them.

Sometimes I wonder if giving the semblance of choice is more important than the ensuring the actual choices are available.

Last week, I felt very autocratic – particularly in my dealings with one individual. It is easy for me to justify by telling myself that he doesn’t have capacity and the choices that I made on his behalf (via an IMCA (Independent Mental Capacity Advocate) are in his ‘best interests’ – but when I stop for a moment in the flurry of work as it arrives at my desk – and realise that I am, in fact, dictating where someone will be living for possibly the rest of their life – it fills me with discomfort.

This isn’t why I wanted to do this job.

I am often faced with this feeling when I carry out Mental Health Act Assessments. I am responsible for making a decision about someone’s compulsory detention in hospital. Of course, for those assessments to take place, the people are very unwell. Sometimes acutely, sometimes chronically. Often the process is distressing and it never involves choice. Occasionally, and I can count the times on the finger of one hand in the past year, we might be able to think about and consider community alternatives – but usually those choices have been explored to the point of expediency by the time the assessment roles around.

Sometimes when I am faced with my own choices, I become increasingly thankful that I have the liberty and wherewithal to be in a position to make these choices.

Choice is a fundamental aspect of our humanity. I see people who lose this on a day to day basis and I see my role in the loss of this choice.

I don’t feel guilty because there is no responsibility attached to me personally. But I do reflect and think how can I make the process of the restriction of choices less overbearing. Some people don’t want to take a part in the processes and prefer to have decisions made for them. Last week, I visited someone who I have been seeing how regularly for about a year – she asked me to make a decision for her. As soon as I had said what, in my opinion, would be the best outcome, she nodded sadly.

I am not sure it was an answer she wanted to hear but it made me more aware that sometimes it can be easier to have others make choices for you but even choosing to delegate that responsibility to someone who you might know and trust – that is an equal essence of humanity.

image Iceman photograpy @ flickr

11 thoughts on “Choice

  1. Very interesting angle about delegating choice. Definately something I will reflect on in my own practice. Do you subscribe to the notion of a generational divide on the choice issue? I certainly feel there is a sharp difference between the relationship people have with the state and their expectations of it which depends on whether they are post-war or post-thatcher.

    • Yes, I think there is a difference. It works some way to explaining the poor take up with direct payments with older people as opposed to younger adults.

  2. This is a great post! I am a patient, and have had more than my fair share of experiences with force in social work. On the other hand, I can see that the social worker whom I consider most oppressive, who used a lot of authority to overpower me verbally and who at one point even threatened to file for limited guardianship if I didn’t sign a particular form (I don’t think she was serious about that), sincerely felt that she was doing all that she did in my best interest. However, this power play did cause me to have a long-lasting mistrust in social workers. I can imagine that it must feel wrong somehow for you as an SW, too, but if the client’s choices have seriously harmful consequences (which in my case they so far haven’t had, by the way),I can see that it is necessary to take away responsibility sometimes.

    • Thanks for the comment, Astrid. And authority, even when it is considered to be in someone’s best interest, is still authority and a type of power-play. I think that’s what makes me uncomfortable – for what it’s worth.

  3. Interesting and thoughtful post cb. Arguably these decisions should be made by people like yourself who don’t actually feel comfortable doing it. If you were comfortable and blase about it, then that would probably be quite worrying.

    • I, however, can edit (a comment which will make no sense to anyone but Z!).
      Thanks.. and I completely agree about not wanting to be comfortable with the decision-making process – the discomfort invites reflection. Earlier this week, I met a worker in another team who told me how desperate she was to become an AMHP. I am always a little disarmed by people who actively and enthusiastically want to do that..

  4. Great post, cb! I think it’s so important to be thoughtful when we are offering people limited choices…it’s a huge responsibility and one I think we should be uncomfortable with.

  5. A very interesting series of comments, thanks for taking the time to share. I must admit that I am hoping to do my AMHP traing in a few months and I am really keen (but not desperate lol) to do it. I’m an RMN with 23 years experience, mostly in liaison/emergency psychiatry and CMHT. Everyone around says that this is something really positive that I am doing, or hoping to do. This isn’t because I want to run round detaining people but because of the experience that I have and what I hope I could contribute. I agree totally that discomfort can and should invite reflection, long may that be the case.

    All the very best.

    • Thanks, KJPR. I found the course (although I did the ASW training!) to be a fantastic learning experience although it was tough going at times (although I had nothing like your experience!). Good luck with it.

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