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Mental Capacity Assessment – what does it involve?

Mental Capacity Assessment – what does it involve?

The Mental Capacity Act- MCA (2005) defines how others can make decisions on behalf of someone who lacks capacity.

If a person is unable to make a certain decision at a particular time because of illness, a Mental Capacity Assessment should be carried out to ensure the person's interests are protected.

A Mental Capacity Assessment should ideally be carried out face to face, and with a professional who is trained in the statutory principles of the Act. 

Mental Capacity Assessments are decision specific, a person may not be able to decide which interest rate is better for their savings, but they may be able to choose their clothing and the activities they wish to participate in.

Gone are the days where capacity assessments are generic to all aspects of a person’s life and care choices. There are some circumstances where the Act does not permit decisions to be made on behalf of a person who lacks capacity e.g., family relationships or marriage.   

Before proceeding, the assessor must identify the specific decision which needs to be made and then consider why the person's capacity is in question.

They must confirm that the person has an impairment or disturbance in the function of their mind giving details, for example, a dementia diagnosis. They then confirm that because a person has this condition their ability to make the decision is impaired. This diagnostic testing applies to both permanent and temporary conditions.    

The assessor should assume that a person has the capacity as a starting point and take all practical steps to help them make a decision. This may involve looking at alternative ways the person can communicate such as using sign language. 

They should respect that a person has the right to make an unwise decision, and this does not in itself indicate a lack of capacity. 

They must consider the timing of the assessment. A person’s capacity may fluctuate, they may be more alert in the mornings for example, and become disorientated or confused later in the afternoon.

If there is no appropriate person close to the individual to help them with the decision an Independent Mental Capacity Advocate (IMCA) may be instructed.  This may also happen if there are conflicting opinions amongst family members. Other professionals involved in the person's care should also be consulted such as their GP or a District Nurse.   

The assessor will consider functional aspects of decision making, such as; is the information understood? Can the person retain the information long enough to make a decision? Can they weigh up the pros and cons? Can they communicate their decision? They may ask that the person express their view on the decision or describe what they think is wrong with their health. They may ask the person to compare risks regarding the proposed action and explore alternatives. 

If they conclude that a person is unable to make the decision they must ensure, as far as possible, that any decision made on their behalf is in their best interests. They must also consider other, less restrictive options, for example, remaining at home with a care package of support rather than residing in a care home.

When deciding what is in the person's best interests, the assessor must consider factors such as the person's past values and feelings and consult as widely as possible with all those involved with the person’s care.    

The assessment should be clearly documented particularly if the decision is significant, such as when Deprivation of Liberty (DoLS) is being considered. 

The outcome of the assessment and the best interest decision can be challenged by the person or their representative. A formal complaint should be raised with the local authority or clinical commissioning group. Complaints can also be raised through the local government or health service ombudsmen. 

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