2.4 Explain ‘capacity’ as defined in the Mental Capacity Act 2005

This guide will help you answer 2.4 Explain ‘capacity’ as defined in the Mental Capacity Act 2005.

The Mental Capacity Act 2005 is a significant piece of legislation in the UK. It aims to protect and empower individuals who may lack the mental capacity to make specific decisions. An understanding of what ‘capacity’ means within this context is essential for health and social care professionals.

Defining Capacity

The term ‘capacity’ refers to the ability of an individual to make a particular decision at a specific time. It is not a fixed state but can vary. Someone may have the capacity to make certain decisions but not others. For example, an individual might be able to decide what to wear but may lack capacity to manage complex financial affairs. The assessment of an individual’s capacity is not based on their age, appearance, or any diagnosis they may have. Instead, it is based on their ability to understand, retain, and weigh the relevant information to make a decision. The understanding mental capacity act provides a legal framework for assessing a person’s capacity and making decisions on their behalf if they lack capacity. This legislation helps to ensure that individuals receive the necessary support and protection, while also respecting their autonomy and rights.

The Principles of the Act

The Mental Capacity Act 2005 outlines five key principles related to capacity:

1. Presumption of Capacity: Every adult is assumed to have capacity unless proven otherwise. This means you shouldn’t assume someone can’t make a decision just because they have a particular condition.
2. Right to Make Unwise Decisions: Having capacity means individuals can make decisions others might consider unwise. It’s important not to label someone as lacking capacity just because their choice seems odd.
3. Support to Make Decisions: Before determining someone lacks capacity, it’s essential to provide all possible support to help them make their own decisions. This could involve simplifying information or using aids like pictures.
4. Best Interests: If someone lacks capacity, any decision made for them must be in their best interests. This involves considering their past and present wishes, feelings, and beliefs.
5. Less Restrictive Option: Any action or decision made on behalf of someone lacking capacity should interfere as little as possible with their rights and freedoms.

Assessing Capacity

Capacity is decision-specific. This means you must assess it relative to the particular decision at hand.

Two-Stage Test

1. Functional Test: Can the person understand, retain, and weigh up the information needed for the decision, and communicate their decision?
2. Diagnostic Test: Is there an impairment of, or disturbance in, the functioning of the mind or brain? If the answer is yes, it balances with the functional test to determine capacity.

Practical Steps

• Understand: Ensure the person understands the information relevant to the decision.
• Retain: Check if they can retain the information long enough to make the decision.
• Weigh Up: Can they weigh up the information to arrive at a choice?
• Communicate: Can they communicate their decision through any form of communication?

Fluctuating Capacity

Capacity can sometimes fluctuate. An individual might have capacity at one point but might lack it later due to various factors such as mental health conditions or medication effects. Regular assessments might be necessary for individuals with fluctuating capacity.

Capacity and Age

The Act applies primarily to individuals aged 16 and over. However, specific provisions allow decisions for those under 16 in certain situations, usually involving healthcare.

Case Examples

Example 1: Financial Decisions

A woman with early-stage dementia may be able to decide what to eat but may not have the capacity to handle her financial matters. She retains information about her diet but struggles with complex financial concepts. Supporting her involves breaking down financial decisions into simpler terms to enhance understanding.

Example 2: Medical Treatment

A man with severe depression might have difficulty making healthcare decisions during episodes. By explaining treatment options using simple language and ensuring decisions aren’t rushed, professionals provide necessary support.

Barriers to Capacity

Many factors can temporarily affect capacity:

• Emotions: Stress, anxiety, or grief can hinder decision-making.
• Environmental Factors: Noise, distraction, or unfamiliar settings may impact capacity.
• Communication Barriers: Language differences or disabilities could hinder understanding.

Professionals need to address these barriers by creating a calm environment and using appropriate communication aids or interpreters.

Legal Decisions

If a decision-maker determines someone lacks capacity, any decision or action taken on their behalf should aim to benefit that individual. This is done under the ‘best interests’ principle, which requires considering the least restrictive options.

Summary

Understanding ‘capacity’ under the Mental Capacity Act 2005 is essential for safeguarding and supporting individuals in making decisions. The Act emphasises respect for autonomy, ensuring individuals retain as much control over their lives as possible. By identifying and overcoming barriers and assessing capacity with sensitivity, professionals can make informed and ethical decisions aligned with the individual’s best interests.