Mental Capacity Assessments

Helping you understand Mental Capacity Assessments – when, why and who should do them?

At first glance mental capacity assessments and the Mental Capacity Act can seem fairly daunting concepts to get to grips with. However, the subject really isn’t as complicated as it might seem on the surface and most of the content covers actions and activities you’d recognise from your own best practice as a care provider.

This article will help you to understand what mental capacity is, what the Mental Capacity Act is, work out when you should perform an assess­ment, why they need to be performed, how you do them and who in a care setting is best placed to get involved.

What is mental capacity?

Mental capacity isn’t a state which is all-or-nothing. Commonly people feel that diagnoses such as Alzheimer’s, dementia or learning disabilities – even heightened levels of frailty, automatically mean someone lacks the capacity to make their own decisions. This is not always the case!

Mental capacity is defined as the “ability to make your own decisions” and  can be broken down down into four main questions:

  • Does the person understand the information given to them about a specific decision?
  • Can the person retain information long enough to make the decision?
  • Could the person assess the information available to make a decision?
  • Is the person able to communicate their decision?

What is the Mental Capacity Act?

The Mental Capacity Act 2005 (also known as the MCA) is an act designed to help protect and empower people who might lack the mental capacity to make their own decisions about their care and treatment.

When should you perform a mental capacity assessment?

It’s not easy to ensure that someone isn’t wrongly stopped from making decisions that are rightfully theirs to make. Nevertheless, a person needs to be protected from making decisions when they don’t have the capacity.

Before you decide that an individual lacks capacity to make a decision for themselves, you need to ensure that you’ve:

  • Made sure that the person you’re assessing has all the necessary information they need
  • Ensured that they have been given any information on alternatives
  • Tried to breakdown the information into a simpler format
  • Attempted to communicate in a non-verbal fashion
  • Tried to facilitate communication with another person involved, such as a relative or carer
  • Recognised patterns when the person’s understanding is better and focus on those times
  • Assessed the location and ensure that the individual feels at ease
  • Attempted to delay the decision until a time when the person might be better able to make the decision

When should someone’s mental capacity be assessed?

Someone’s mental capacity needs to be assessed when they are:

  • Making decisions at risk of putting themselves in dangerous circumstances
  • Are acting in a manner abnormal from their usual behaviours
  • Have a condition that affects the way their mind works
  • Another individual or care professional has observed that the person might lack the ability to make a certain decision
  • They cannot understand the information relevant to the decision
  • They are unable to retain the required information for the decision or weigh it up

How can you assess someone’s capacity?

The Mental Capacity Act puts forth a two-stage test you can perform in order to ascertain a person’s capacity. This is called the, “2 stage test” and consists of:

  • Does the individual concerned have an impairment of, or a disturbance in the functioning of, their mind or brain, whether as a result of a condition, illness, or external factors such as alcohol or drug use?
  • Does the impairment or disturbance mean the individual is unable to make a specific decision when they need to? Individuals can lack capacity to make some decisions but have capacity to make others, so it is vital to consider whether the individual lacks capacity to make the specific decision.
    *Source NHS

Remember someone’s mental capacity can fluctuate, therefore you need to make sure you allow the person time to make a decision themselves. The best way to do this practically is to start a conversation. Ask that person how they got to that particular decision. Remember that they might need more information and so you need to be ready to provide that if at all possible.­

Who should asses someone’s mental capacity?

In a care setting this will typically be carers who are directly concerned with the person at the time. This means that multiple care team members and even teams can become involved in the assessment. However, this isn’t a negative factor, as this will allow a broader time spectrum to be taken into account and how a person’s capacity varies over time. If a care worker feels that they’re following the care plan and have a, “reasonable belief” that the person lacks capacity to make specific decisions they need to make the assessment – this could be anything from accepting food to personal care. This means that their care plans need to be created collaboratively with the person, who agrees to them or an assessment must be made of their capacity to decide if they refuse specific care interventions.

How can Nourish help care teams with mental capacity assessments?

Nourish empowers care workers by providing them with an easy way to plan, record and manage care. This means that carers can easily work with people on their care plans and identify whether they have the capacity to make choices about their particular set of care interventions.

For more information on Nourish, then please get in touch – our team of experts are always happy to help.