Service user cutting own hair

Hi Rosie,

I'm not sure if I will have [online] time later today, but if not I'll give you my own understanding of the law re this tomorrow [I hope] - this one isn't entirely simple, and I think you could well get differing opinions.

Hi again Rosie,

Here is my 'take' on this - I tend to analyse the Mental Capacity Act in connection with end-of-life, not this type of care situation, so I'm thinking and writing as I go.

Point 1 - 'learning difficulties'.

This term seems to cover an awful lot - but having a learning difficulty, does not automatically equate to a lack of mental capacity: mental capacity as a concept/test, is decision-specific.

In this case, and in fact for any situation, the issue is: 'Does the person understand the consequences of his/her decision ?'. If the answer is 'yes', then the person possesses mental capacity, and legally the decision is the person's to make. So you would need to try and find out, does she understand that the way she is cutting her hair, is causing her to be treated 'negatively in public' ? If she knows that, but answers 'so what - I don't care [how other people see/treat me] then it looks as if it is her decision. It is arguably still her decision, even if that 'negative treatment' might include something like 'people attacking you physically' provided she understood the risks and consequences of such physical attacks.

If she doesn't understand the 'negative consequences', then she doesn't have capacity to make the decision herself. But, anyone making the decision, would have to consider (balance against the direct consequences of her cutting her own hair in this way) things including:

a) Would taking the shaver away from her, cause her distress and to resent the staff ?

b) If she has her hair cut at a salon, does she have to pay for this ? By which I actually mean, would she be left with less money to spend on other things [which she might value more than a salon hair cut] ?

The MCA as I read it, is all about the consequences of actions as understood or not by the individual, and almost entirely it is 'selfish' - care homes obviously have some 'problems with' this, but the MCA doesn't require that a person 'is nice to everyone else': if she has the mental capacity to understand that her haircut would distress other people, but 'doesn't give a damn about that', then my understanding is that the MCA cannot be used to stop her.

I would try to persuade her to get her hair cut at a salon, even if the first time she isn't herself paying for that: then you can ask 'can you see the difference ?' (if she answers 'yes' that suggests capacity re this hair-cutting issue, whereas if she can't 'see' an obvious difference, that suggests a lack of capacity for 'haircutting'). But if she wants to cut her own hair, however 'weird that makes her look', I think you are on dodgy legal ground if she understands the consequences of cutting her own hair and you prevent her from doing that.

I'm not sure if that helps - but, 'off the top of my head', that would be my 'take' on the legal situation, here.

Thank you Mike. She appears not to understand how some of her actions are percieved and does lack MC in certain areas. Staff have 'best interest' guidleines for areas such as healthy food choices. In my professional opinion I would say she does not have MC around the impact the shaving of her hair has on her appearence. Also I think some staff here are worried about what others may think of them. Is this a reflection upon them? Do people think they are responsible for cutting her hair like that? Thanks again, Rose

Hi Rosie, this is an unusual situation, one I have not had deal with, the idea of taking away the razor is tricky, but I agree with the fact that they may have made themselves more vunerable re: comments and taunts it is a question of MCA and their understanding, you do not say if she has family/friends that may talk with her.
hope it gets sorted
Rita

I'm not sure that in [legal] principle, 'Also I think some staff here are worried about what others may think of them. Is this a reflection upon them? Do people think they are responsible for cutting her hair like that?' should have an influence: but I'm sure that in reality, that type of thing DOES have an influence (there are very similar issues to that, around CPR in my EoL area).

The MCA is, to be frank, 'often a sod to work with' if you are the front-line staff: it promotes patient autonomy, but I think it is quite hard to explain to many people/relatives 'I know it seems weird, but the law actually says ...'.

I hope this problem is resolved to the satisfaction of her and the staff - but I also hope that many more people will 'throw their opinions about this one in here', because this is a really 'interesting question and discussion'.

Hi Rosie,I shared this with my staff and this is what we think:
First of all  will to look into her background, it could be that she was a hairdresser or have ever worked in a salon or even just got interest in hair dressing. If there is no relation at all then will look into the the kind of hair style she used to have before coming to live there.The second thing we will do is, get a hair dresser to the home and engage her to watch and see her reaction then advice her that she could have a proper hair do from the person. If this works then she could then have regular visits from the person.Thirdly, as she has not got Capacity we will lock the razor away in her 'Best Interest'and supervise her in cutting or having a hair do.RegardsJohannes

On Thursday, 8 January 2015, 20:01, Dignity Champions forum <[log in to view email address]> wrote:

Message sent by Rita Umney.

Hi Rosie, this is an unusual situation, one I have not had deal with, the idea of taking away the razor is tricky, but I agree with the fact that they may have made themselves more vunerable re: comments and taunts it is a question of MCA and their understanding, you do not say if she has family/friends that may talk with her.
hope it gets  sorted
Rita

Hello Rosie

I have read with interest the service users situation,have you and staff used pictures to explain her haircut,like how she wore her hair before and after she has shaved her hair,also could she have some sensory feeling when she uses the razor on her hair and eyebrows.Just a suggestion to use pictures explain accessible to her of what she is doing,remember all accessible ways of communicating information have to be utilised before lack of mc can be assessed.

There was a piece in Nursing Times online (Jan 9th) headlined 'Some practice nurses lack training in mental capacity laws, finds CQC' and in the comments beneath it, I did point at this 'hair-cutting' discussion and provide the link. One poster on NT asked 'what were the replies to the hair-cutting question ?' (I had posted the DIC question, in my first NT post).

I do think that this particular situation, highlights a quite complex issue re 'mental capacity', and it is well-worth pondering !

Whether most staff who work in the NHS have got the time 'to ponder over issues, to arrive at the best answer' is a different - and also interesting - question !

what a challenge, there is a real issue around the challenges of respecting Dignity in this case. There are as I see it two main themes, the Dignity of the service user in terms of the potential outcomes on how others might see her, and her capacity to understand that; and the Dignity of staff in terms of how people who are outside the situation may perceive their actions or 'lack of action'. It is always a difficult one and there is no one answer. None of us who are commenting have full knowledge of the situation, and the life choices that have been made by and on behalf of the individual concerned, and as such it becomes really difficult to make any helpful comments. [not helpful in itself I know]. I do think the use of pictures as suggested may be helpful, as would having a wider best interest type discussion about the outcomes and what may happen in terms of choices. There is a conflict for me in terms of this may be one of the few areas where the individual still has control over her life and I have an innate reluctance to take that away from anyone, even if I don't agree with the outcome on a personal level. Maybe the real key is the degree to which leaving the razor in place has a negative impact on the individual in terms of the reactions of others, versus the potential negative impact of taking the razor away and thus taking that little bit of control and choice away.
I am sorry if this is not helpful in terms of providing answers, but this is a real dilemma and there is no right or wrong answer. I do hope you find a way forward that enables you to continue to provide choice and self determination as well as the duty of care that you so clearly take seriously. Best Wishes

I'm not sure that Liz is right, about there not being 'a correct answer' to this one: I think that unless mental incapacity is established, there is a clear answer (it is up to the lady herself); if the lady lacks capacity, I would agree that the answer is less clear, and that then different people could legitimately arrive at different answers.