A Guide to Mental Capacity Assessment

Summary

This video provides an overview of mental capacity assessments, focusing on the Mental Capacity Act of 2005. It outlines the five core principles of the Act, emphasizing that capacity is assumed unless proven otherwise. The video explains how to assess someone's ability to understand, retain, weigh, and communicate decisions. It also addresses the importance of considering a patient's best interests when they lack capacity, and discusses Deprivation of Liberty Safeguards (DoLS). The video concludes with advice on seeking help and resources for making informed decisions in complex cases.

Takeaways

• 🧠 Mental capacity refers to the ability to make decisions and understand their consequences, with the assumption that individuals have capacity unless proven otherwise.
• 📜 The Mental Capacity Act (MCA) was established in 2005 to protect the rights of adults to make decisions for themselves, with five core principles guiding its application.
• 🔄 People must be helped to make decisions for themselves, even if their choices seem unwise, as long as they understand the risks and benefits.
• ⚖️ A capacity assessment involves checking whether the individual can understand, retain, weigh, and communicate information to make decisions.
• 👥 Decisions for individuals who lack capacity should be made in their best interests, taking into account their previous beliefs and wishes.
• 🏠 Capacity assessments are decision-specific and should involve the individual whenever possible. Less restrictive options should always be prioritized.
• 🏥 In non-emergency situations, it's good practice to hold a best interest meeting, involving family members, friends, or representatives familiar with the patient.
• 🔒 If someone is deprived of liberty (e.g., confined to a hospital ward for safety), a Deprivation of Liberty Safeguards (DoLS) order must be arranged and regularly reviewed.
• 💡 Some situations require special consideration, such as if the individual has appointed a lasting power of attorney or has an advance decision to refuse treatment.
• 📝 Capacity assessments may need to be repeated as capacity can fluctuate over time, and healthcare professionals should always seek help when uncertain.

Q & A

What is mental capacity?

Mental capacity is the ability to make decisions and understand their consequences. It is the cognitive ability to process information, make choices, and understand the implications of those choices.

What are the five principles of the Mental Capacity Act of 2005?

The five principles are: 1) Capacity is assumed unless proven otherwise. 2) People must be supported to make decisions for themselves. 3) People are allowed to make unwise decisions. 4) Decisions for those who lack capacity must be made in their best interests. 5) The least restrictive option should be chosen when making decisions for someone who lacks capacity.

How can you assess a patient's capacity to make a decision?

To assess capacity, the patient must be able to understand and retain information, weigh it to make a decision, and communicate that decision. This assessment should be decision-specific, and the person assessing should be knowledgeable about the decision being made.

What should be done if a patient lacks capacity to make a decision?

If a patient lacks capacity, decisions should be made in their best interests. In emergency situations, a doctor can make the decision. For non-emergency situations, a best interest meeting should be held, including someone who knows the patient. The least restrictive option should be chosen.

Can patients make unwise decisions if they have mental capacity?

Yes, people with mental capacity are allowed to make unwise or risky decisions, as long as they are within the law. The Mental Capacity Act acknowledges that poor decisions do not necessarily mean a lack of capacity.

What steps can be taken to support a patient in making a decision?

To help a patient make a decision, barriers such as medical issues, sensory impairments, or language barriers should be addressed. This could include treating underlying health problems, using interpreters, or providing communication aids.

What happens if a patient lacks capacity and has no family or friends?

If a patient lacks capacity and has no friends or relatives, an independent mental capacity advocate (IMCA) should be appointed to represent their interests during decision-making.

What are Deprivation of Liberty Safeguards (DoLS) and when are they applied?

DoLS are legal safeguards for people who lack capacity and are being deprived of their liberty, such as being placed in 24-hour care or having restricted movement. DoLS must be arranged if necessary and last up to 12 months.

What role does a lasting power of attorney (LPA) play in capacity assessment?

If a patient has appointed a lasting power of attorney (LPA) for health and welfare, the person with LPA will make decisions on behalf of the patient if the patient loses capacity. This must be in place before the patient loses capacity.

What is a 'best interest' meeting and who should be involved?

A 'best interest' meeting is held to make decisions for patients who lack capacity. It should include the patient (if possible), family members, friends, or representatives like an independent mental capacity advocate. The aim is to make decisions that reflect the patient's beliefs, wishes, and interests.