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This chapter asks the reader to consider communication needs at the point of decision making during statutory assessments. It focuses on participation of the person, framed here as shared decision making (SDM). Providing first the policy context and principles as to why this should happen, the chapter explores ways in which SDM can be supported for those who are deemed to have capacity, and also for those who may not. Discussing concepts such as insight and the use of jargon, the author explores the paternalism that can affect decision making, which in turn leads to a person not being meaningfully included in decisions made about them. Given the seriousness of the outcome of a Mental Health Act (MHA) assessment, such participation is key. It is argued that developing and enabling reciprocity is fundamental to SDM, and that the navigation of these boundaries is underpinned by attitudes, styles and skills. Concluding with a discussion of their own research, and developments such as Open Dialogue, the author looks ahead to the emerging shifts that may be seen in forthcoming changes suggested for mental health legislation in England and Wales.
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