Is There a Role for Supported Decision-Making for People Who Have Mental Health Histories?

Nina Loewenstein, J.D., and Lisa Volpe, J.D.

“Supported decision-making” is a decision-making process developed primarily for people with intellectual disabilities. The person with the disability selects supporters whom they trust. Supporters commit to gathering and providing needed information, discussing the pros and cons of a choice being considered, and can advocate to ensure the individual’s decisions are known and respected. The goal of the model is to maximize the individual’s autonomy and self-determination. Courts have recognized informal as well as formal decision processes as alternative resources avoiding the need for guardianship over the individual.

A growing number of state laws recognize supported decision-making agreements for people with disabilities, and in many ways formalize these processes. New York is likely to join Illinois in requiring third parties to legally recognize supported decisions (made under formal agreements), but only for people with intellectual disabilities. Yet, people with mental health histories are also too often presumed to lack capacity to make important decisions affecting their daily lives. We will review the elements of supported decision-making underlying the growth in legislation, and discuss (the relatively few) models and practices specifically designed for people with mental health histories. We will facilitate a discussion to consider whether there are supported decision-making practices that would benefit people with mental health histories and avoid coercive decision practices, such as guardianship or treatment over objection. What are the factors that can impact a person’s decision-making? Can supported decision arrangements be helpful for sustaining autonomy in times of developing crisis? Are there risks to employing such a model? If so, can they be mitigated? Can supported decision-making facilitate the execution of advance directives for health care decisions?

Learning Objectives:

  • Gain an understanding of supported decision-making models;
  • Learn to what extent such models or practices are legally recognized as supporting the decision of the individual;
  • Consider whether there are potentially useful supported decision-making practices for people with mental health histories, to further support autonomy in a strength-based manner.