4.3 Evaluate the support available when mental capacity needs to be assessed, and how to access this support

This guide will help you answer 4.3 Evaluate the support available when mental capacity needs to be assessed, and how to access this support.

Assessing mental capacity is a critical aspect of care and support in adult services. For managers and leaders, understanding the types of support available for assessments and how to access them ensures compliance with the Mental Capacity Act 2005 (MCA) and other relevant legal frameworks. This guide covers what support is available during capacity assessments and how to make the best use of these resources.

The Purpose of Support in Mental Capacity Assessments

Support helps ensure that assessments are fair, accurate, and conducted in line with legal principles. It also guarantees that the individual is placed at the centre of the process.

Support is needed to:

• Help staff understand and apply the MCA principles.
• Secure person-centred, evidence-based assessments.
• Ensure decisions are legally sound and defensible.
• Provide specific expertise or input where cases are complex.
• Respect the person’s rights and ensure proper advocacy.

Identifying and accessing the right support is essential for both the individual being assessed and the staff involved in the process.

Types of Support Available

Training and Education

Consistent staff training is fundamental for carrying out legally compliant and person-centred capacity assessments. Training ensures that all workers involved:

• Understand the legal principles and definitions within the MCA.
• Learn the correct steps for conducting and recording capacity assessments.
• Gain awareness of their own responsibilities and limitations in the process.

Managers should evaluate training quality and regularly refresh staff knowledge, particularly for new or updated guidance surrounding mental capacity.

Supervisors and Managers

Supervisors and managers provide hands-on support for staff conducting assessments. They can:

• Offer guidance in interpreting MCA principles.
• Review documentation to check that processes are correctly followed and legally sound.
• Help clarify doubts or concerns when assessing complex cases.
• Provide reflective supervision after assessments to discuss lessons learned or to address difficulties.

Managers play a pivotal role in fostering confidence among staff, helping them handle sensitive assessments, and ensuring compliance with organisational procedures.

Specialist Professionals

Certain cases may involve complexities requiring specialist expertise. Examples of professionals who can assist include:

• Social Workers: Experienced in conducting formal mental capacity assessments for safeguarding and care planning.
• Occupational Therapists: Assist by providing functional assessments that help evaluate how a person interacts with their environment and how this affects their ability to make decisions.
• Psychologists or Psychiatrists: Offer expertise when a mental health issue or cognitive impairment (e.g. dementia, brain injury) creates uncertainty over capacity.
• Speech and Language Therapists (SALT): Play a key role in supporting individuals with communication difficulties, ensuring they are effectively enabled to convey their understanding and preferences.

Involving specialists can improve the accuracy and fairness of assessments by providing additional insights and expertise.

Advocates

Advocacy is crucial if the individual being assessed has no family members or carers available to represent their views. Advocacy resources include:

• Independent Mental Capacity Advocates (IMCAs): Statutory advocates appointed in specific circumstances under the MCA. For example, an IMCA must be involved when best interests decisions are being made about serious medical treatment or long-term accommodation changes for someone without family or friends to consult.
• Advocacy Services: Local advocacy organisations often provide additional support for individuals who are vulnerable or unable to speak for themselves. Advocacy ensures that the individual’s wishes, feelings, and rights are represented throughout the capacity assessment process.

Accessing advocacy support is particularly important where there may be disputes or concerns about coercion or bias in decision-making.

Medical Input

Doctors or healthcare professionals are often needed to provide medical evidence related to a person’s condition. They can help clarify how an individual’s physical or mental health is affecting their capacity to make specific decisions. For example:

• General Practitioners (GPs): Often involved in providing medical history and understanding of an individual’s current condition.
• Consultants or Specialists: May offer more detailed diagnoses or opinions in complex cases (e.g., conditions such as stroke, dementia, or brain injury).

Engaging medical professionals ensures that assessments are based on an informed view of the person’s health and its impact on cognitive function.

Legal Support

Legal advice and support may be required for particularly contentious or high-risk cases involving mental capacity. Solicitors or legal teams can assist with:

• Understanding the implications of case law and legal precedent for specific circumstances.
• Requesting guidance or decisions from the Court of Protection.
• Reviewing or drafting formal documents such as advance decisions, lasting powers of attorney, or care agreements.

Legal support ensures compliance with legal requirements and helps to prevent challenges or disputes.

Local Authority Resources

Local authorities have statutory duties under the MCA and Care Act to provide support related to mental capacity assessments. They are often the first point of contact for:

• Advice on whether specific cases require a formal assessment.
• Allocating a suitable social worker or IMCA for complex or statutory cases.
• Approving Deprivation of Liberty Safeguards (DoLS) authorisations.
• Funding access to specialist professionals or advocates in certain cases.

Local authority resources are essential for managing both day-to-day capacity issues and more serious concerns requiring safeguarding or legal interventions.

Peer Support and Networks

Care professionals working together can share knowledge and experiences of assessing capacity. Peer learning helps staff:

• Review real-life case studies and compare approaches.
• Discuss challenges in group settings, e.g., team meetings or reflective practice sessions.
• Build confidence through collaborative decision-making.

Peer networks are especially helpful when staff feel uncertain or isolated in challenging cases.

Strengths and Weaknesses of Available Support

Strengths

1. Diverse Expertise: Plentiful access to multi-disciplinary professionals (e.g., social workers, psychologists, advocates) improves decision-making.
2. Legal Safeguards: Resources like the Court of Protection and IMCAs ensure assessments are legally compliant and protect individual rights.
3. Promotes Person-Centred Care: Support focusing on communication and advocacy ensures individual voices are heard.
4. Minimises Risks: Professional and legal input reduces the likelihood of flawed or unfair decisions.

Weaknesses

1. Resource Limitations: Advocacy services or specialist professionals can be overstretched, causing delays in support.
2. Training Gaps: Inconsistent or outdated staff training might lead to poor application of MCA principles.
3. Access Barriers: GPs or healthcare specialists may be hard to reach, especially during busy periods, reducing timely medical input.
4. Over-reliance on Local Authorities: Some organisations may lack internal resources and depend too heavily on local authorities for expert support.

Being aware of these weaknesses allows managers to prioritise areas for improvement and ensure consistent access to quality support.

Accessing Support for Capacity Assessments

Internal Organisational Procedures

Many organisations have internal protocols for accessing support. Managers should:

• Refer to the MCA policy or capacity assessment guidance embedded in organisational policies.
• Use established referral pathways to specialists within the organisation (e.g., supervision from senior management or in-house therapists).
• Ensure staff know how to escalate complicated cases and where to seek help within the service.

Local Authority Pathways

To access external support such as IMCAs, social workers, or safeguarding professionals, managers should:

• Contact their local authority’s adult social care team for advice.
• Submit formal referrals where appropriate (e.g., for DoLS authorisations or social work involvement).
• Build relationships with key local authority staff to ensure quick responses for urgent cases.

Advocacy and Specialist Services

Advocates and specialists often operate through local partnerships or voluntary organisations. To access their services:

• Identify local advocacy groups, especially those providing IMCA services.
• Develop a directory of contacts for speech and language therapists, psychologists, and mental health professionals.
• Work with Clinical Commissioning Groups (CCGs) or Integrated Care Boards (ICBs) to identify available experts in the region.

Legal and Professional Guidance

If legal input is required:

• Liaise with the organisation’s legal department or external solicitors familiar with health and social care law.
• Use resources provided by the Court of Protection for guidance on deputyship or legal disputes.

Workforce Development

Managers should proactively arrange continuous professional development (CPD), ensuring access to up-to-date MCA training and relevant procedural updates for all team members. External trainers or online learning platforms may also improve staff knowledge without requiring significant time away from work.

Strengthening Support Systems

While support mechanisms exist, managers should regularly evaluate how effectively they meet the organisation’s needs. Consider the following:

• Are current referral systems streamlined and quick?
• Is specialist input provided promptly and in line with care priorities?
• Are staff confident in using local pathways to arrange advocacy, training, or legal advice?
• Could more resources be directed toward staff training on complex cases?

By strengthening weak support links, services can better meet their legal and ethical obligations.

Final Thoughts

Support during capacity assessments is critical to ensuring fair and consistent decision-making. Training, advocacy, specialist professionals, and legal advice all contribute to robust assessments. However, accessing these resources requires strong leadership, familiarity with local pathways, and a commitment to improving organisational systems. Managers must ensure that services remain person-centred and compliant with the Mental Capacity Act by using the available support wisely and addressing any gaps in provision.