Understanding the Mental Capacity Act (MCA) 2005 is essential for anyone working in health and social care. The Act ensures that individuals who may lack the capacity to make decisions for themselves are protected and supported. A crucial part of this is the assessment of capacity.
This guide will walk you through the essential questions and considerations you need to take into account while conducting a mental capacity assessment.
What is a Mental Capacity Assessment?
A Mental Capacity Assessment determines whether an individual has the ability to make specific decisions. It is not a blanket judgement about someone’s overall capacity but is decision-specific. The assessment must consider the individual’s ability to understand, retain, use, weigh information, and communicate the decision.
Key Principles of the Mental Capacity Act
Before diving into the assessment guide, it’s important to recall the five guiding principles of the MCA:
- Presumption of capacity: Always start by assuming the person has capacity.
- Support to make a decision: Offer all practicable help before concluding someone lacks capacity.
- Right to make unwise decisions: Understand that making an unwise decision doesn’t necessarily mean a person lacks capacity.
- Best interests: Any decision or action taken on behalf of someone who lacks capacity must be in their best interests.
- Less restrictive option: Always opt for the least restrictive option.
The Two-Stage Test of Capacity
The MCA requires a two-stage test to assess mental capacity:
- The Diagnostic Test: Is there an impairment of, or disturbance in, the functioning of the person’s mind or brain?
- The Functional Test: Is the impairment or disturbance sufficient that the person is unable to make a specific decision when required?
If the answer to the first question is yes, then proceed to the functional test.
Assessment Questions Guide
Understanding the Information
For someone to make a decision, they must understand relevant information. Ask questions such as:
- Can you tell me what this decision is about?
- Do you understand the main points and issues regarding this decision?
- Do you know what will happen if you make this choice?
Retaining the Information
Individuals must retain the information long enough to make a decision. Ask:
- Can you repeat the key points we discussed about this decision?
- What do you understand about the consequences of this decision?
Using and Weighing the Information
Individuals should be able to weigh the information as part of the decision-making process. Ask:
- How do you think this information affects your options?
- What are the pros and cons of this decision?
- Why did you choose this option over the others?
Communicating the Decision
Communication is key. If an individual can communicate their decision, this must be respected, irrespective of the method. Ask:
- Can you tell me what decision you have made?
- Show me how you would like to communicate your decision.
Recording the Assessment
Document thoroughly. Your records should include:
- Detailed notes on how you conducted the assessment.
- The person’s responses to questions.
- Your reasons for determining whether the person has capacity.
When to Involve Experts
Sometimes, you might need to involve health and social care practitioners or other professionals:
- When there’s a significant impact of the decision.
- If there is disagreement about the person’s capacity.
- When making decisions about life-sustaining treatment or significant medical interventions.
- In situations involving legal implications or significant financial matters.
Best Interest Checklist
If someone lacks capacity, the decision must be taken in their best interests. Follow these guidelines:
- Avoid decisions based solely on the person’s age or appearance.
- Consider all relevant circumstances.
- Delay the decision if the person is likely to regain capacity.
- Encourage the person’s participation.
- Take into account the person’s past and present wishes, feelings, beliefs, and values.
- Consult with involved people, like family members or friends.
Involving the Person in Decisions
Even if the person lacks capacity, they should be involved as much as possible:
- Provide all relevant information.
- Present information in a way that aids understanding – use pictures, videos, or simplified language.
- Discuss decisions at times when the person is most likely to comprehend.
Legal Safeguards and Best Practices
Understanding legal obligations ensures compliance and protects both the individual and the provider:
- Ensure staff are aware of and trained in the MCA principles.
- Regularly review assessments to ensure ongoing compliance.
- Always document the involvement of any attorneys or deputies appointed under the Lasting Power of Attorney or Court of Protection.
Restraint and the Use of Force
The Mental Capacity Act permits the use of restraint only when absolutely necessary:
- Ensure the restraint is necessary to prevent harm and is proportionate to the risk.
- Keep records of any restraint used and routinely review these decisions.
When to Use the Mental Health Act
Sometimes, the Mental Health Act 1983 may be used instead of the MCA, such as when:
- The person meets conditions for detention under the Mental Health Act.
- Medical treatment cannot be given safely without detention.
Addressing Disagreements
Disagreements will happen. Address concerns by:
- Asking assessors for evidence.
- Seeking explanations from decision-makers.
- If unresolved, refer to the Office of the Public Guardian or the Court of Protection.
Building a Supportive Framework
Regularly consult with your local council and primary care trusts to ensure you adhere to the MCA. They provide training, support, and resources that can make a significant difference in compliance and quality of care.
This guide aims to make the principles and questions of the Mental Capacity Act clear and actionable. Conducting thorough, respectful, and legally compliant assessments is vital in health and social care, ensuring the dignity, rights, and well-being of individuals are always at the forefront. This structured approach not only protects those in your care but also supports you as a provider in fulfilling your legal and ethical obligations.
