Speech and language therapists play a key role in determining a person’s mental capacity (their ability to make decisions) and supported decision-making. Speech and language therapists protect and promote the interests of people with communication needs by supporting them to demonstrate whether or not they have decision-making capacity. They promote inclusion, dignity, choice, and equality of access to services. They also reduce the potential risk of people with communication needs being wrongly deemed as lacking capacity and, in some extreme cases, being deprived of their liberty (having decisions about their care or treatment made on their behalf in hospitals, care homes and other settings) unnecessarily because their individual needs have not been properly assessed and supported.
An Increasingly Important Issue
Demographic changes are resulting in an increasing need for mental capacity assessments. Speech and language
therapists work with a wide range people for whom mental capacity assessments may be necessary. These include
people with:
• Head and neck cancer
• Learning disabilities
• Traumatic brain injury
• Mental health problems
• Progressive neurological conditions (such as dementia, Parkinson’s disease, motor neuron disease, and multiple
sclerosis)
• People who have had a stroke
All of these can have a significant impact on an individual’s communication and thinking skills, including:
• Comprehension
• Expression
• Retention and recall
• Reasoning
Communication and thinking difficulties can have an impact on:
• A person’s capacity – someone with a communication disability may also have cognitive difficulties due to the
nature of their condition (e.g. dementia). These cognitive difficulties may mean the person lacks the capacity to make
certain decisions.
• A person’s ability to demonstrate that they have capacity – a person with a communication disability may
have capacity to make decisions, but not the means to communicate it if their disability is left unsupported.
• Other people’s perceptions of their capacity – a person with a communication disability may be at risk of being
determined not to have capacity if people working with and caring for them mistake their communication disability for a
lack of capacity.
The Role Of Speech And Language Therapists
Speech and language therapists are registered health practitioners who support people with communication and swallowing needs.
They are uniquely trained and qualified to:
• Undertake in-depth, detailed assessments of an individual’s current, and likely future, ability to communicate, including
their ability to understand, express themselves, retain and recall information, and reason (weigh up different options)
• Carry out capacity assessments themselves and/or contribute to multidisciplinary capacity assessments of people with
communication needs
• Support people with communication needs to demonstrate their decision-making capacity
• Support people who cannot make informed decisions to express their preferences and wishes in relation to any
decision made on their behalf
• Advise and train people on the best means by which someone with a communication disability might overcome their
disability so they can make and communicate informed decisions about their treatment and care
• Support people to understand how to communicate with individuals who have been found to lack decision-making
capacity
Speech and language therapists are experts in inclusive communication, removing barriers to communication and
advising and training others to do so. This includes encouraging people to adapt their communication styles to meet
people’s individual needs and supporting individuals to communicate in whichever way suits them. This can involve the
use of supported and Augmentative and Alternative Communication – using writing, gestures, signing, symbols and
pictures, word boards, communication boards, and other forms of technology to support or replace spoken communication.