How can a brain injury affect capacity and decision-making

Brain injuries can have profound and long-lasting effects on a person’s life. While physical symptoms may be visible, many of the most significant challenges arise from cognitive changes that affect decision-making, planning and day-to-day functioning. 

The video below is an except from our recent interview with Helen Goddard, Senior Brain Injury Case Manager at Head First, we explored how brain injuries can impact a person’s ability to make decisions and manage everyday tasks. Helen explained that injuries affecting the brain often impair what are known as executive functions, the cognitive skills responsible for planning, problem-solving, foresight and self-monitoring.

For individuals who lack capacity or struggle with decision-making, everyday choices can become overwhelming. Tasks that might seem simple, such as choosing what to eat or managing their finances, may require significant support. 

In these situations, deputies and case managers often work together to ensure that individuals receive the legal protection and practical support they need while still maintaining as much independence as possible.

Why everyday decisions may become difficult after a brain injury  

Executive functions are a set of cognitive processes that allow us to organise our thoughts, regulate behaviour and make decisions. 

These functions include: 

• problem solving 

• planning and organisation 

• foresight and insight 

• self-monitoring 

• risk assessment. 

For most people, these processes operate automatically. However, when the brain is injured, these can become significantly impaired. This means individuals with brain injuries may struggle with tasks that require multiple steps or complex thinking. 

Clients may struggle to make even basic decisions, such as: 

• choosing what to eat 

• deciding how to spend money 

• planning daily activities 

• organising appointments. 

These difficulties can be confusing and frustrating for the individual, particularly when they are aware that something has changed but cannot fully understand why. In some cases, recognising these limitations can also be emotionally challenging.  

While physical limitations may be easier to recognise, cognitive impairments can be harder for individuals to identify. As clients gradually gain insight into the challenges they face, this can sometimes be emotionally difficult. Realising that certain abilities have changed may require time, support and adjustment. 

Brain injuries can also affect a person’s ability to assess risks and solve problems. This means that individuals may find it difficult to evaluate the consequences of their actions or recognise potential dangers. As Helen explains, executive functioning can be so impaired that it affects everyday judgement and reasoning. 

Because of this, clients may require ongoing support to help them navigate situations that involve financial decisions, personal safety or long-term planning. The role of a case manager is to support a client to navigate these changes, through rehabilitation. 

How brain injury may affect financial decision-making 

Financial management can be particularly challenging for individuals with cognitive impairments. Tasks such as budgeting, paying bills or managing bank accounts require several cognitive skills working together. 

Court of Protection deputies and case managers may therefore support clients in different ways depending on their abilities. 

For example: 

• some clients may be able to participate in budgeting using structured tools such as spreadsheets 

• others may require additional support to manage bank accounts or direct debits. 

The goal of  deputy is often to support a client to maintain as much independence as possible while ensuring that financial decisions remain safe and sustainable.  

A key principle of the Mental Capacity Act is that individuals should be supported to make their own decisions wherever possible. Rather than making decisions for the client, professionals often adopt strategies to help clients to move forward and regain independence overtime. This might involve for example breaking complex choices into smaller steps. 

For example: 

• focusing on one decision at a time 

• simplifying financial options 

• providing structured guidance. 

A deputy should support a client to decision make in this way. This approach helps individuals remain involved in decisions affecting their lives, even where additional support is required. 

In some situations, professionals may need to make best interests decisions where a client is unable to make a particular decision themselves. 

Supporting individuals with impaired decision-making often requires collaboration between several professionals. Deputies may be responsible for managing financial affairs or making certain legal decisions. 

Case managers, on the other hand, often help implement practical support strategies that enable clients to participate in daily life. 

By working together, these professionals can ensure that individuals receive both: 

• legal protection where capacity is limited 

• structured support to maximise independence.

Conclusion 

Brain injuries can significantly affect a person’s ability to plan, make decisions and manage everyday tasks. These cognitive changes are often less visible than physical injuries but can have a profound impact on independence and quality of life. 

Through collaboration between Court of Protection deputies, case managers and rehabilitation professionals, individuals who experience these challenges can receive the legal protection and structured support needed to navigate daily life and maintain as much independence as possible. If you require support or advice, please send your enquiry to mail@anthonygold.co.uk or call us on 020 7940 4060.