Supported decision making

Setting the threshold of understanding

The CMSL principle (Farmer, 2016) is a tool to assist with accurately identifying the threshold of understanding which should be done prior to the assessment. It can also be a helpful tool to use if there are disagreements regarding an individual’s capacity as it can help to identify the specific area where there is disagreement. 

This tool divides the information a person needs to consider in relation to a particular decision into four main areas: Concept, Mechanics (or practicalities), Short term or Long-term duration (hence the CMSL Principle). 

For example, the ability to manage property and financial affairs may contain some of the following: 

  • Concept: What is money? Where does it come from? The fact that it is finite in nature 
  • Mechanics: How do you practically get your money? How do you invest? What are the practicalities of managing money? 
  • Short term: This might cover day to day budgeting. What does the person need to know or demonstrate in relation to this, for example what is your income? Do you have any regular outgoings? 
  • Long term: This would cover the longer-term investment of larger sums of money, for example how would you make your compensation payment last for 30 years? How would you identify that something is a good investment or not? Do you have any long-term medical needs you might need to pay for? 

When identifying the extent to which an individual should understand the information it is important that professionals do not: 

  • set expectations too high thereby creating unrealistic criteria that any person with capacity would struggle to meet 
  • set expectations too low meaning people will be deemed to have capacity who otherwise do not. 

Use the ‘average person on the street’ test meaning you consider what level of detail you would expect the average person to know about the particular decision you are being asked to address. Using this ‘test’, it becomes clear that it is not necessary for the individual to have a solid grasp of all the specific details, merely the salient facts. However, it is important to consult appropriate professional when necessary.