Mental Capacity Act

Capacity

-Refers to a person's legal and mental ability to understand information, weigh it up, and make a specific decision for themselves.

-Capacity is one of the main issues that distinguishes the MCA from MHA

-Capacity is not always lost in mental disorder

MHA

-Patient must be experiencing a mental illness which is severe enough to warrant inpatient treatment, because there is a significant risk of harm to self, to others, or a significant degree of vulnerability.

-People may lack capacity, but not always.

-E.g. someone who is depressed, with a clear plan to end their life, but otherwise cognitively intact – MCA would not apply, but MHA could to preserve safety.

-The HCP proposing the intervention is responsible for completing the capacity assessment

Capacity assessment 1

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

Capacity assessment 2

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 .

Capacity assessment 3

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 1

Need for a specific decision- An assessment is required when a person needs to make a specific decision, such as consenting to or refusing a health or care intervention.

Triggers for capacity assessment 2

Concerns raised by others- Someone else raises a concern that the person may not have the capacity to make a particular decision.

Triggers for capacity assessment 3

Change in circumstances-A person's circumstances, like the death or move of a carer, or a referral to an adult protection co-ordinator, may trigger an assessment.

Triggers for capacity assessment 4

Unexplained behaviour- The person's behaviour or actions suggest they may not be able to make a decision.

Triggers for capacity assessment 5

Temporary incapacity-The person may be temporarily unable to make a decision due to factors like medication, illness, or injury. The assessment should be postponed until their capacity has improved, if possible.

MCA 2 Stage test

-The 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.

The two stage test

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

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

-This could be due to long-term conditions such as mental illness, dementia, or learning disability, or more temporary states such as confusion, unconsciousness, or the effects of drugs or alcohol (the diagnostic test).

Important points about the capacity assessment

•Capacity Assessments are time / decision specific

•Patients shouldn’t be written off as lacking all capacity due to diagnosis

•Especially in early stages of dementia

•Patients are allowed to make ‘unwise decisions’

•Onus is on clinician to maximise capacity particularly during assessment

•Explore communication aids

•Language barriers

•Wait! If cause is temporary we shouldn’t be making life altering changes such as accommodation, major surgery etc.

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.

Principle 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 acting in the best interest of someone lacking capacity must consider or act in a way that would interfere less with the person’s rights and freedoms of action or whether there needs to decide or act at all. Any intervention should be weighed up in the particular circumstances.

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.