John is in a hospital experiencing an acute mental health crisis that has impacted his cognition, emotional regulation, and behavior in significant ways. He knows where he is, what date it is, and what time it is, and he understands that he is in the hospital for treatment because of an acute mental health episode. But his speech is impaired and his thoughts sometimes disorganized. Mateo, a social worker, sees John during his initial assessment of John. When asked by Mateo to describe what is important to him, John draws a picture of his family and says he wishes to care and provide for his family. John writes five words by this drawing, "THIS IS MY LIFE'S PURPOSE." When asked what John needs to accomplish that, Johns says he needs a job that earns at least $100,000 a year, an objectively reasonable estimate. John expresses worry that while his current job provides that salary, he might lose his job if he spends too long in the hospital, an objectively reasonable concern.

After a few weeks in the hospital, during which Mateo does not visit or talk with John again, Mateo visits John a second time. Mateo tells John that is severely mentally ill, and that medication is his only treatment option. John vigorously shakes his head. He writes down on a notepad that medications have, in the past, harmed him with side effects and that he has responded well to CBT therapy. Both of John's observations are objectively true and evident in John's medical files, though medication as a treatment option in John's case is also strongly supported by the medical literature. After a few minutes, Mateo cuts John off, crumples John's written note, and dismisses John's reluctance with a waive of his hand, stating, "Hey, look, man, you wanna get out of the hospital? Just do what the psych says - this is his area and he's the expert, he knows what's good for you." Mateo ends the visit, stating, "when you're ready to get on board with what the psych says and take some responsibility, let me know; otherwise, I'll see you around. It's all on you, man." John is left feeling angry and unheard after this encounter.

22 A) John must be competent to make a treatment decision leave the hospital. Using at least two of the "Standards / Notions of Competence," make an argument with each chosen Standard as to why John might or might not be competent to understand his treatment options. You must use the facts from John's case to support your answer.

22 B)How would you best describe the kind of decision-making approach Mateo appears to be using with John? Explain your answer.

22 C)What specific facts would you change to align Mateo's approach to Shared Decision-Making? You must specify what you would change about Mateo's approach and why.