The process of a mental health capacity assemement

The order of MCA assessment

1. diagnostic test and 2 step test (to know if they have some conditions to that might affect the ability to make a decision)

2. Functional test

3. The 5 principles of MCA

Diagnostic test process

This where the first visit uses screening test while the second visit uses the actual diagnostic test is the longer second step

MCA 2 stage test

is a legal framework used under the UK's Mental Capacity Act (2005) to determine whether an individual has the mental capacity to make a specific decision for themselves.

Although capacity can be impaired by mental disorder, MCA usually covers treatment of physical health issues or social decisions.

Questions

Is the person unable to make a particular decision? THE ISSUE

Is that inability due to an impairment / disturbance of the mind or brain?

The functional test

First principle

A person must be assumes to have capacity , as professional you must start from a place where the person is assumed to be able to make decisions

Reasons to believe the person lacks capacity because:

-The person has substantial difficulty in understanding relevant information

-The person has substantial difficulty retaining the information

-The person has substantial difficulty using or weighing up the information part of the process

-The person has substantial difficulty communicating their wishes or feelings .

Prior to formally assessing the persons capacity identify

-What is the decision to be made?

-What are the problems or difficulties the person is experiencing relating to the decision?

-What support do they need?

Triggers for capacity assessment

An assessment is required when a person needs to make a specific decision, such as consenting to or refusing a health or care intervention. Some of the triggers are:

-Concerns raised by others

-Change in circumstances (E.g. the move or death of a carer)

-Unexplained behaviour

-Temporary incapacity (due to factors like medication or illness like delirium)

Principle 1 of MCA

A presumption of capacity: every adult has the right to make their own decision and must be assumed to have capacity unless proven otherwise. Eg.,you can’t assume someone cant make a decision because of a medical condition/disability

Principle 2 of MCA

Individuals being supported to make their own decisions: a person must be given practicable help before anyone treats them as not being able to make their own decision by encouraging/ supporting people to make their own decisions even when they do lack capacity.

Principal 3 of MCA

Unwise decision: people should not be assumed to be lacking capacity just because a patient makes a decisions deemed as unwise by others. Everyone has their own values, beliefs and preferences which may not be the same as others.

Principle 4 of MCA

Best interest: anything done on the behalf of the person lacking capacity must be done in the best interest.

Principle 5 of MCA

Less restrictive option: someone making a decision or acting on behalf of a person who lack capacity, should act in a way that interferes less with the person’s right and freedom of action or whether is a need to act or decide at all.

What is best interest?

-The act provides a non-exhaustive checklist of factors that decision-makers must work through in deciding what is in a person’s best interest.

-A person can put values, past wishes, and quality of life into a written statement if they wish, which the person determining capacity must consider.

-In addition, the HCP caring for the person lacking capacity have to be consulted concerning a person’s best interest.