Project title:
Balancing Autonomy and Risk in Social Care Practice
Research Leads:
Dr Jeremy Dixon – Reader in Social Work, CARE
Research Members and collaborations:
- Dr Sally Hewlett – Department of Education, University of Bath
- Dr David Frances Hunt – Department of Psychology, Exeter University
- Professor Judy Laing – University of Bristol Law School
Funder(s): GW4
Funding amount: £4976.20
Project start date: January 2025
Project end date: June 2025
Introduction:
Social care practitioners in England and Wales face significant ethical and practical challenges in balancing autonomy and risk. Current law states that all individuals have a right to autonomy with the Mental Capacity Act 2005, stating that individuals should not be judged to lack capacity because they make ‘unwise decisions’. However, Local Authorities in England and Wales are also given duties to protect ‘adults at risk’ from abuse or neglect (a process known as ‘adult safeguarding’). Case law in this area is complicated, meaning that practitioners face practical challenges. This project will explore the issue through a literature review and a community event with people who use social care services, social care workers, social workers and leaders in social care.
Overview:
This project is funded by GW4, which supports collaborations by Bath, Bristol, Cardiff and Exter Universities. GW4 supports projects which address real world challenges. This project is funded by a GW4 development award, which support the development of collaborations through a single activity.
The project will run between January to June 2025. It is led by Dr Jeremy Dixon from the Centre for Adult Social Care Research at Cardiff University with Dr David Frances-Hunt (University of Exeter), Dr Sally Hewlett (University of Bath) and Professor Judy Laing (University of Bristol).
During the project, the team will conduct a literature review, informed by realist principles. The findings from this review will be presented to people who use social care services, social workers and social care leaders at a consultation event. The consultation event will create space for dialogue, shared motivations, and learning. The event will be used to identify practice dilemmas which occur when balancing autonomy and protection and what researchers need to focus on to improve practice in this area.
Background:
The Mental Capacity Act 2005 has been seen as a landmark piece of legislation in England and Wales and regulates personal decision-making for adults regarding their health, welfare, property and affairs. The Act is important for people with mental health problems as it protects their right to make autonomous decisions whilst also indicating the protections they should have if they lack mental capacity to do so.
Although the individual right to autonomy is protected through the Mental Capacity Act 2005, Local Authorities are also given duties to protect people from harm in England and Wales (a process known as ‘adult safeguarding’). These duties are given under the Care Act 2014 in England and the Social Services and Wellbeing (Wales) Act 2014 in Wales (which set out how local authorities should work with adults with care and support needs who are experiencing, or at risk of abuse and neglect). Serious case reviews (now safeguarding adults reviews), have noted a lack of consensus about how services should reconcile a proper respect for autonomy against a duty to protect individuals, when they are unable to care for themselves (Plymouth Safeguarding Adults Board, 2017, Braye et al., 2015).
The challenges of balancing safety against autonomy (in the Mental Capacity Act) when protecting vulnerable adults from harmful influences or dangerous behaviour have been recognized by the Court of Protection (MN v A City Council [2021] EWCOP 62). The principles also have relevance for international practice, as international human rights frameworks, such as the UN Convention on the Rights of Persons with Disabilities place obligations on professionals to respect the autonomy of disabled people, whilst protecting them from abuse (Fallon-Kund et al., 2017). Moreover, research suggests that professional approaches to risk assessment and management are diverse and guidance is needed to better assist staff with balancing risk, safety and autonomy (Clemens and Hayes, 1997, Dickens et al., 2023), whilst research focusing on the views of service users around mental capacity and adult safeguarding decision-making remains notably sparse (see, Dixon, 2023).
In summary, social care practitioners in England and Wales commonly face significant ethical and practical challenges, in balancing autonomy and risk. Our multidisciplinary team aims to establish a foundation for addressing this issue. We will review existing research and grey literature, and bring together a community of practice involving researchers, stakeholders, and individuals with lived experience. This will help structure our approach, offer valuable insights, and serve as a basis for a future research bid.
BRAYE, S., ORR, D. & PRESTON-SHOOT, M. 2015. Learning lessons about self-neglect? An analysis of serious case reviews. The Journal of Adult Protection, 17, 3-18.
CARE ACT 2014.
CLEMENS, E. L. & HAYES, H. E. 1997. Assessing and balancing elder risk, safety and autonomy: Decision-making practices of health care professionals. Home Health Care Services Quarterly, 16, 3-20.
DICKENS, G. L., AL MAQBALI, M., HALLETT, N., ION, R., KEMP, C., SCHOULTZ, M. & WATSON, F. 2023. Mental health nurses’ attitudes towards risk assessment: An integrative systematic review. Journal of Psychiatric and Mental Health Nursing, 30, 1137-1151.
DIXON, J. 2023. Adult Safeguarding Observed: How Social Workers Assess and Manage Risk and Uncertainty, Bristol, Policy Press.
FALLON-KUND, M., COENEN, M. & BICKENBACH, J. E. 2017. Balancing autonomy and protection: A qualitative analysis of court hearings dealing with protective measures. International Journal of Law and Psychiatry, 53, 69-76.
MENTAL CAPACITY ACT 2005.
PLYMOUTH SAFEGUARDING ADULTS BOARD 2017. Safeguarding Adult Review. Ruth Mitchell. Plymouth: Plymouth Safeguarding Adults Board.
SOCIAL SERVICES AND WELLBEING (WALES) ACT 2014.
Study methods and activities:
By creating a community of practice across research and social care, we will identify the relationships between the gaps in the research and needs of social services, and opportunities to leverage funding. This development award is designed to:
- To conduct a rapid review of the literature, identifying current legal guidance on this issue, what current practice guidance suggests as well as relevant research in the area.
- To conduct a one-day consultation event with key stakeholders (individuals with lived experience of using social care services, carers, unqualified social care workers, social workers, principal/consultant social workers, managers and commissioners).
Findings:
Study ongoing
Further information: