DSS could assist up to 5,500 people in its first six months of operation

A report carried out to forecast demand for a new service to assist those with decision-making capacity abilities shows that 1 in 20 of the population may require access to the Decision Support Service at some point in their lives. This includes all those who choose to plan ahead for the future.

The Decision Support Service (DSS) is a new service established by the Assisted Decision-Making (Capacity) Act 2015 to promote the rights and interests of adults who may require support to make decisions about their personal welfare, property, and affairs.

Demand Forecasting

The DSS needs to understand the likely demand for the range of supports provided for under

the 2015 Act. This report sets out the approach and results of a two-phase demand forecasting project undertaken by the DSS. As the DSS is a completely new service in Ireland, the aim of the project was to gain insights and understanding of the number and needs of potential users of the service.

As well as identifying potential users, the approach enabled researchers to include those who may benefit from the service in the future. Starting with an examination of the whole population, the broadest possible definition of disability was applied to include relevant difficulties such as those that are self-perceived, as well as medically-diagnosed difficulties and conditions.

Available to the entire adult population

The supports under the Act will be available to the entire adult population in Ireland. There is no prerequisite to have a diagnosed condition or illness. Any adult who needs decision-making support, whether occasionally or continuously, will be able to benefit from the supports. The functions of the DSS include the promotion and regulation of the new support arrangements.

There is no single data source in Ireland of adults who require support to make decisions. There is a range of available data sources that include people with cognitive difficulties, and specific diagnoses and conditions that are frequently, but not invariably, associated with an increased difficulty with decision making.

Other persons that may need the services of the DSS include those in residential care facilities. There are up to 44,000 adults in residential care facilities in Ireland. All adults have a presumption of capacity and not all adults in residential care will require the supports available under the Act, but the available data was nevertheless evaluated.

Up to 1 in 20 adults in Ireland identified as potential users via census and three national surveys

A baseline population of likely DSS users was established using a non-diagnostic data source

(Census 2016), supported by three nationally representative surveys which asked more in-depth

questions allowing for cross-analysis and providing a mechanism to validate census data.

The baseline population range as identified was adjusted to 2021 population levels providing

a baseline population range of 125,406 to 201,064. This represents 3.3% to 5.2% of the adult population (1 in every 20 adults). The baseline population does not represent the actual numbers likely to seek DSS services. To calculate annualised figures, a review of comparable jurisdictions was undertaken together with data from the Office of the Wards of Court in Ireland.

An estimated 7,408 individuals are expected to access the DSS in its first year of service, rising to 7,942 in 2026. A reasonable estimate for the first six months of operations (July to December 2022) would be 5,556 decision-support arrangements, according to the report.

Dublin and regional cities have highest number of those with DSS needs

In terms of geographical breakdown for service need, it is unsurprising that larger urban centres of population have the highest numbers in terms of DSS service need. This includes the four administrative areas of Dublin - Dublin City, Dún Laoghaire Rathdown, Fingal, and South County Dublin, along with Cork County and City, Galway, and Limerick.

The new support service will be under the remit of the Mental Health Commission and the chief executive of that body, John Farrelly, said that its establishment will be a progressive and important development for Irish society.

The Director of the Decision Support Service, Áine Flynn, said: “At different times in our lives, we all need to make decisions. We make important decisions about our finances, property, employment, accommodation, healthcare, and social supports. Some people - due to various factors or circumstances - may struggle with this due to compromised health or other issues.

 “This includes current adult wards of court,” said Ms. Flynn. “Almost 2,000 people have been made wards of courts since the Assisted Decision-Making (Capacity) Act 2015 was enacted. All adult wards will have their cases reviewed by the wardship court and must transition out of wardship within three years of commencement.

 “When we are up and running next year, there will be a graduated framework of arrangements for people who have challenges with their decision-making capacity and who may need to access appropriate support. These arrangements are based on the different levels of support that a person requires to make a specific decision at a specific time. I look forward to the benefits that the 2015 Act and the DSS will bring for many people.”

You can read the full report here.