“UPON the court being satisfied that [EXB] lacks capacity to make various decisions for himself in relation to a matter or matters concerning his property and affairs, and that the purpose for which this order is needed cannot be as effectively achieved in a way that is less restrictive of his rights and freedom of action. … IT IS ORDERED THAT: 1. Appointment of deputy (a) [Ivan Finbarr Barry] … is appointed as deputy (“the deputy”) to make decisions on behalf of [EXB] that he is unable to make for himself in relation to his property and affairs, subject to any conditions or restrictions set out in this order. … 2. Authority of deputy (a) The court confers general authority on the deputy to take possession or control of the property and affairs of [EXB] and to exercise the same powers of management and investment, including purchasing selling and letting property, as he has as beneficial owner, subject to the terms and conditions set out in this order. (b) If the deputy considers it in [EXB’s] best interests to do so [he] may appoint an investment manager, who is regulated and authorised to undertake investment business, to manage his assets on a discretionary basis under the standard terms and conditions applicable to such service from time-totime, and to permit the investments to be held in the name of the investment manager nominee company. (c) The deputy may make provision for the needs of anyone who is related to or connected with [EXB] if he provided for, or might be expected to provide for, that person’s needs by doing whatever he did, or might reasonably be expected to do, to meet those needs. (d) The deputy may (without obtaining any further authority from the court) dispose of [EXB’s] money or property by way of gift to any charity to which he made, or might have been expected to make, such gifts, and, on customary occasions, to persons who are related to or connected with him, provided that the value of each such gift is not unreasonable having regard to all the circumstances and, in particular, the size of his estate. (e) For the purpose of giving effect to any decision the deputy may execute or sign any necessary deeds or documents.”
“Even now when we have a system of him receiving a not insignificant amount of money on Thursday to last him the weekend, and a top-up at the beginning of the week, EXB still struggles with his money. He is unable to control his impulses. For example, he has received a large amount to purchase presents for his daughter, and blown it on other things over the course of a couple of days. EXB is also quite impressionable, and very vulnerable. Some of the people that he associates with, putting it in a nice way, are not desirable. EXB would not be able to stop himself telling such people about a settlement figure. He is already vulnerable to being exploited by such people. He frequently talks about owing money to his associates. There is no way that his support group, whether his Deputy, myself or his support worker, can actually verify that he has borrowed money, and is required to repay it.”
“In that state of mind he cannot rationalise, and it increases his frustration. He gets to the point where he has smashed walls, smashed telephones, thrown other things within his house – because he gets himself so worked up over money. In my opinion, everyone who knows EXB, and knows him well, would say that it is not in his best interests to know a specific figure because he would not cope with knowing that figure. It would cause no end of problems, and increase his vulnerability. He has never said to any of his support team “How much have I got”, and actually says as long as he has got the peace of mind of knowing that his future is secure, and he has his wages, then he is content. Having a figure in EXB’s head would, in my view, feed the issues that he has. It would feed his impulsivity, an impulsive nature and requests for money. Even now, without that knowledge, he has asked for funds to purchase a van when he does not have a licence to drive, he has bought hundreds of £s worth of trainers in a couple of days.”
“With EXB it is fair to say that there is a constant push push push for more money. In my experience when lucid and calm he can hold a degree of insight into the fact that his damages are intended to pay for his support, and meet his lifetime needs for life. However, in my view that insight is limited, quickly overtaken and circumvented by a request for immediate funds for his latest material purchase. There is always something material that in his view, he needs to purchase and he cannot look beyond that immediate subject and the frustration that in many ways he creates for himself. In my view, having further information about his financial settlement exacerbate that situation.”
“His thought processes are, generally speaking, rigid and concrete. He is very perseverative. The matters that generally become integrated in [his] mind are his own perspectives, and arguments that he often creates himself, and ruminates upon. This leads to escalation in frustration, often manifesting in anger, and the further diminishing prospect of him taking on board information. Therefore, his injury, cognitive and executive dysfunction, result in it being difficult to support him with understanding information and concepts. He will have his initial perception, and it is difficult to support him to explore views beyond that initial perception. Clearly his understanding of matters is not always incorrect, and is dependent upon the complexity of the issue at hand. However, with issues that have a multiple of levels and consequences, his understanding is generally speaking limited to his basic limited solitary perspective. In simple terms he is not someone that can be easily supported, by talking them through a problem to assist their understanding of all of the relevant factors.”
“I believe he also has a basic appreciation that some of his compensation is intended to pay for his support and meet his future needs. However, in my view, that appreciation is likely to be somewhat superficial due to his cognitive and executive problems. He is unlikely, for example, to think about the need for money in the future in a real world everyday environment. Advance planning is not his immediate and natural way of thinking. When calm and not preoccupied by matters that he perseverates over, I think that within the confines of an office or the like and with support, in that moment he would recognise points such as the necessity of an award lasting a lifetime. However, in my opinion, the key issue is that even if he could be supported to understand such concepts in the context of a quiet office, he still would not apply such concepts to his everyday thinking and decision making. EXB’s understanding and decision making is very much in the moment. Generally speaking it is isolated from the advice, information and support that he has previously received. I have seen example after example of EXB being sent money for a specific and allocated purpose, and yet when he has that money he will spend it on the first possible thing that occurs to him. He will not spend money on what even he himself had planned. He will spend money in an impulsive disinhibited rush. Although it is fair to say that at times he has, in a quiet structured environment demonstrated some retrospective understanding of these problems, this insight and appreciation does not translate to a change with EXB’s thought processes and decision making in the outside world.”
“The first issue, to my mind, would be his vulnerability. If he were to have knowledge of a specified sum he would have a significantly compromised and basic appreciation of its intended purpose. Such knowledge would translate and impact upon his behaviour. In plain terms I know that if EXB knows that he has a specific sum of money he (a) perseverates over it and cannot move beyond thinking about what he’s going to spend it on, and (b) he will seek to spend money that he has in his head – even if he doesn’t physically have it. It would, in my view, escalate his existing vulnerabilities to himself and his own actions. It would also escalate his vulnerability to others. In my clinical opinion knowledge of a crystallised figure from his perspective would cause him to be more vulnerable to his own impulses, and increase his vulnerability to other people who might, for example, propose to borrow money from him … He, in my experience, constantly lives beyond his means. This situation is not mediated by the amount he receives. It results in him borrowing money, and him being in a seemingly unbreakable cycle of what he refers to as “owing money out”
“(1) In determining for the purposes of this Act what is in a person's best interests, the person making the determination must not make it merely on the basis of— (a) the person's age or appearance, or (b) a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about what might be in his best interests. (2) The person making the determination must consider all the relevant circumstances and, in particular, take the following steps. (3) He must consider— (a) whether it is likely that the person will at some time have capacity in relation to the matter in question, and (b) if it appears likely that he will, when that is likely to be. (4) He must, so far as reasonably practicable, permit and encourage the person to participate, or to improve his ability to participate, as fully as possible in any act done for him and any decision affecting him. (5) … (6) He must consider, so far as is reasonably ascertainable— (a) the person's past and present wishes and feelings (and, in particular, any relevant written statement made by him when he had capacity), (b) the beliefs and values that would be likely to influence his decision if he had capacity, and (c) the other factors that he would be likely to consider if he were able to do so ….”
“The principles of the present Convention shall be: 1. Respect for inherent dignity, individual autonomy including the freedom to make one’s own choices, and independence of persons; 2. Non-discrimination; 3. Full and effective participation and inclusion in society ….”
“5.21 Wherever possible, the person who lacks capacity to make a decision should still be involved in the decision-making process (section 4(4)). 5.22 Even if the person lacks capacity to make the decision, they may have views on matters affecting the decision, and on what outcome would be preferred. Their involvement can help work out what would be in their best interests. 5.23 The decision-maker should make sure that all practical means are used to enable and encourage the person to participate as fully as possible in the decision-making process and any action taken as a result, or to help the person improve their ability to participate. 5.24 Consulting the person who lacks capacity will involve taking time to explain what is happening and why a decision needs to be made. Chapter 3 includes a number of practical steps to assist and enable decision-making which may be also be helpful in encouraging greater participation. These include: • using simple language and/or illustrations or photographs to help the person understand the options • asking them about the decision at a time and location where the person feels most relaxed and at ease • breaking the information down into easy-to-understand points • using specialist interpreters or signers to communicate with the person. This may mean that other people are required to communicate with the person to establish their views. For example, a trusted relative or friend, a full-time carer or an advocate may be able to help the person to express wishes or aspirations or to indicate a preference between different options.”
“The court may make declarations as to— (a) whether a person has or lacks capacity to make a decision specified in the declaration; (b) whether a person has or lacks capacity to make decisions on such matters as are described in the declaration; (c) the lawfulness or otherwise of any act done, or yet to be done, in relation to that person.”
“In my experience, with people who are moderately or severely impaired and have executive problems, [information as to the level of the award] can (but not always) be disruptive. That individual might be vulnerable to their impulses. They might be vulnerable to temptation to alcohol or illicit drugs. Their distorted perception of a sum can lead to destabilising grandiose ideas. For example that person might contemplate cancelling their care, on the assumption that they will be saving money which will give them money for other things. Of course at face value there is an element of truth to this, but this is often at the cost of the stabilising influences on their lives – which is not foreseen. The crystallisation of a figure can be at the root of these destabilising ideas. Often once those ideas are formed no amount of rationalisation or explanation can deter that person from that avenue - as a consequence of their executive dysfunction rather than a genuine considered decision. For the avoidance of doubt, I am speaking in general terms here, and not specifically with regard to EXB. Further I am not suggesting these issues occur with every patient involved in litigation. Each patient and their individual needs and difficulties are clearly different. However, such issues with patients who have moderate to severe impairments and executive dysfunction occur frequently.”