Supporting people to make decisions
Brain injury can significantly impact on a person's ability to make decisions. Decision making is a complex activity that requires a number of processes working together. Long-term memory, working memory, emotions and insight are all involved. Because any one or all of these processes can be impaired by a brain injury, difficulties with decision making are a common problem.
This page gives information on how to help people make their own decisions after brain injury, and gives guidance on how to act on their behalf if they are unable to do so.
The effect on family and carers
In the immediate aftermath of brain injury a person may be in a coma or post-traumatic amnesia, and family members will be required to manage finances. At this stage, clinicians will need to consider treatment decisions. However, they should take into consideration the wishes of the patient and their close family.
During the recovery process, cognitive, behavioural and emotional problems can make it impossible for brain injury survivors to understand the consequences of their decisions. In some cases, the effects of brain injury can leave people unable to manage their own affairs or make decisions about their welfare.
These changes can be permanent, so long-term arrangements may need to be put in place to enable decisions to be made in a person's best interests.
How to make decisions on behalf of someone who lacks capacity
England and Wales
Headway's booklet Mental capacity: Supporting decision making after brain injury (PDF) has been written for anyone who lives in England and Wales and is concerned about another person's ability to make decisions. It explains the principles of the Mental Capacity Act, which can help you to assess the person's decision making ability.
Information is also provided on applying to the Court of Protection, which may be necessary in order to make decisions on their behalf. It explains how you can ask the Court of Protection to make a single decision, appoint you as a deputy to manage a series of linked decisions, or become an appointee to manage their welfare benefits.
The process of making decisions on behalf of a person who lacks capacity can be complex, as there are a number of safeguards in place to protect their welfare and independence. If you are concerned about a person's ability to make decisions, you should familiarise yourself with the legal process for acting on their behalf, and in many cases it can be helpful to seek legal advice from a solicitor who has experience of brain injury.
Headway's factsheet A guide to the Adults with Incapacity (Scotland) Act (PDF) provides a simple guide to the law surrounding capacity issues in Scotland. It explains how to assess capacity, and gives details of the options available if you need to act on someone's behalf.
Capacity issues are dealt with by the High Court in accordance with the Mental Capacity (Scotland) Act 2016. The Act is relatively new with related changes still underway, so you should seek legal advice as to the best course of action if you have concerns over somebody's welfare.
Isle of Man and Channel Islands
In the Isle of Man and the Channel Islands, capacity issues are dealt with under common law, so you should always seek legal advice.
Helping people to make their own decisions
All possible efforts must be made to allow a person to make their own decisions, and there are a number of aids and strategies that can be used to help them do so. In more severe cases, these should be explored with the support of a rehabilitation team, either as an in-patient in the early stages of recovery, or as an out-patient after the person is discharged.
With the right help and support, the effects of this common symptom can often be lessened, making everyday decisions much easier for the person with a brain injury, as well as their family and carers.
Headway's factsheet Difficulties with decision making after brain injury (PDF) provides more detailed information to help you understand the causes of the problem, and describes some practical strategies that can help.