Mental Capacity Act and Restraint Guide

The Mental Capacity Act (MCA) is a law in England and Wales that protects and gives power to people who may not be able to make certain decisions for themselves. Here are its core principles:

  1. Every adult is assumed to have the capacity to make their own decisions unless proven otherwise.
  2. Help should be given to people to make their own decisions if they can.
  3. People have the right to make decisions that others might think are unwise.
  4. Decisions made for someone who lacks capacity must be in their best interests.
  5. Actions taken for someone without capacity should interfere as little as possible with their rights and freedom.

Regarding restraint, it is any method used to limit a person’s freedom or movements and can only be used if:

  • The person doing it believes it is necessary to stop harm,
  • The amount of restraint used is in proportion to the risk and seriousness of that harm.

Restraint might involve physically stopping someone from moving, or it could be less obvious, like using medication that limits their actions. It should always be a last resort, after exploring all other less restrictive ways to prevent harm, while also respecting the individual’s rights and dignity.

Mental Capacity Act and Restraint Potential Issues

When applying restraint under the Mental Capacity Act, several issues may arise:

  • Inadequate Assessment: Incorrectly determining that someone lacks capacity when they do not, or failing to provide adequate support to allow the individual to make their own decision, could lead to unnecessary use of restraint.
  • Excessive Use: Using more restraint than necessary can infringe on an individual’s rights and may be considered abuse.
  • Injury: Physical restraint can lead to unintended harm or injury to the individual being restrained or to the caregiver applying the restraint.
  • Psychological Impact: Restraint can cause psychological harm, including trauma, fear, and a loss of trust in caregivers.
  • Legal Consequences: If restraint is used improperly, it can result in legal action against the caregiver or care home for breaching the MCA or human rights legislation.
  • Reputation Damage: Misuse of restraint can damage the reputation of the care home and undermine confidence in the care provided.

Careful assessment, adherence to MCA principles, proper training, and documentation are crucial to minimise these risks.

How to Minimise Risks

To minimise risks associated with the Mental Capacity Act and the use of restraint in care homes:

  1. Training: Ensure staff are thoroughly trained in the MCA, including how to assess capacity and apply the Act’s principles. Train staff in de-escalation techniques and non-restraint interventions.
  2. Policies and Procedures: Develop clear policies and procedures that comply with the MCA, specifically around assessing capacity and when restraint may be used, ensuring it is lawful, proportionate, and in the person’s best interests.
  3. Regular Assessments: Conduct regular and thorough assessments of individuals’ capacity to make specific decisions, involving healthcare professionals where necessary.
  4. Supportive Environments: Create a supportive environment that enables individuals to make their own decisions wherever possible.
  5. De-escalation Strategies: Use de-escalation strategies and alternative methods to manage challenging behaviour that could lead to harm.
  6. Least Restrictive Practices: Always consider and use the least restrictive options first.
  7. Individual Care Plans: Develop personalised care plans that include input from the individual, their family, and healthcare professionals.
  8. Monitoring and Review: Regularly monitor and review the use of restraint and update practices as needed.
  9. Documentation: Keep detailed records of any incidents where restraint is used, including the rationale, method, duration, and review.
  10. Legal Advice: Seek legal advice when in doubt about the use of restraint to ensure practices comply with current laws and regulations.
  11. Feedback Mechanisms: Implement feedback mechanisms for both staff and residents to communicate concerns or suggestions related to restraint practices.
  12. Ethical Committee or Advisor: Consider establishing an ethics committee or consulting with an ethical advisor to review complex cases where restraint might be considered.

FAQ

Q: What is the Mental Capacity Act (MCA)? A: The MCA is legislation in England and Wales that protects individuals aged 16 and over who may not be able to make their own decisions regarding their care and treatment.

Q: When is a person considered to lack capacity? A: A person lacks capacity if they have an impairment or disturbance in the functioning of their mind or brain, and as a result, they are unable to make a specific decision at the time it needs to be made.

Q: How should decisions be made for someone who lacks capacity? A: Decisions should be made in the person’s best interests, considering their past and present wishes, feelings, beliefs, and values where possible. The decision should also be the least restrictive option that meets their needs.

Q: What is restraint under the MCA? A: Restraint is any action that uses force – or threatens to use force – to make someone do something they are resisting, or restricts a person’s freedom of movement, whether they are resisting or not.

Q: When can restraint be used legally? A: Restraint can only be used if it is necessary to prevent harm to the person and if the level of restraint used is proportionate to the likelihood and seriousness of harm.

Q: Can restraint ever be planned in advance? A: Restraint should be used as a last resort. However, care plans may include details on how to manage potential situations where restraint might become necessary, ensuring any action taken is lawful and in the person’s best interests.

Q: Who oversees the use of restraint in care settings? A: Care providers are responsible for ensuring that restraint is used appropriately. The Care Quality Commission (CQC) in England and its equivalent bodies in other UK regions regulate care providers and can take action if restraint is misused.

Q: How do you assess if restraint is proportionate? A: To assess if restraint is proportionate, consider the seriousness of harm that could occur without restraint and whether there are less restrictive ways to prevent that harm.

Q: What documentation is required when restraint is used? A: Detailed records should be kept, including why restraint was necessary, how it was applied, the duration, and the outcome. This documentation should be reviewed regularly.

Q: Can family members make decisions about restraint for their relative who lacks capacity? A: Family members can contribute to decision-making by sharing what they know about their relative’s preferences and beliefs. However, the final decision must be taken by the person responsible for care unless a legally appointed proxy has this authority.

Remember to consult with legal professionals or regulatory bodies if in doubt about specific cases involving the MCA and restraint.