Mental Capacity Act Training

Principles of the Mental Capacity Act 2005

The MCA is based on five key principles:

1. Presumption of Capacity:
   • Every adult has the right to make their own decisions unless it is proven that they lack capacity.
   • Assumptions about capacity should not be made based on age, appearance, condition, or behavior.
2. Support to Make Decisions:
   • Individuals should be given all possible help before anyone concludes that they cannot make their own decisions.
   • This may include providing information in an accessible format or involving a trusted friend or relative.
3. Right to Make Unwise Decisions:
   • Individuals have the right to make decisions that others might consider unwise or eccentric.
   • The focus should be on their ability to make the decision, not the decision itself.
4. Best Interests:
   • Any decision made or action taken on behalf of a person who lacks capacity must be done in their best interests.
   • Consider the person’s past and present wishes, feelings, beliefs, and values.
5. Least Restrictive Option:
   • Any decision or action should aim to restrict the person’s rights and freedoms as little as possible.
   • Consider whether there is a less restrictive way to achieve the same outcome.

Assessing Mental Capacity

The Two-Stage Test

1. Diagnostic Test:
   • Does the person have an impairment or disturbance in the functioning of their mind or brain (temporary or permanent)?
2. Functional Test:
   • Can the person make a specific decision when required? This involves assessing if the person can:
     • Understand the information relevant to the decision.
     • Retain that information long enough to make the decision.
     • Use or weigh that information as part of the decision-making process.
     • Communicate their decision (by any means).

Practical Steps

1. Provide Information:
   • Ensure the person has all the necessary information to make the decision.
   • Use clear language, visual aids, or other methods as needed.
2. Assess Understanding:
   • Check if the person understands the information provided.
   • Ask them to explain in their own words.
3. Evaluate Retention:
   • Determine if the person can retain the information long enough to make the decision.
4. Assess Reasoning:
   • Evaluate if the person can use or weigh the information to make a decision.
   • Ask about the pros and cons they see in their options.
5. Check Communication:
   • Ensure the person can communicate their decision through any effective means.

Making Decisions on Behalf of Individuals Who Lack Capacity

1. Best Interests Decision-Making:
   • Involve the person as much as possible in the decision-making process.
   • Consider their past and present wishes, feelings, beliefs, and values.
   • Consult with family members, friends, or anyone else who cares for the person.
   • Consider all relevant factors, including the impact on the person’s health and well-being.
2. Best Interests Checklist:
   • Will the decision achieve the desired outcome?
   • Are there any less restrictive options?
   • Have all relevant circumstances been considered?
   • Is the decision free from discrimination?
3. Documenting Decisions:
   • Keep a detailed record of the decision-making process, including assessments, consultations, and the rationale for the decision.

Advance Decisions and Lasting Powers of Attorney

1. Advance Decisions:
   • Legal documents that allow individuals to refuse specific types of treatment in the future.
   • Must be made while the individual has capacity.
   • Health professionals must respect valid and applicable advance decisions.
2. Lasting Powers of Attorney (LPA):
   • Legal documents that allow individuals to appoint someone to make decisions on their behalf if they lose capacity.
   • Two types of LPA:
     • Property and Financial Affairs LPA: Decisions about money and property.
     • Health and Welfare LPA: Decisions about health and personal welfare.
3. Role of the Court of Protection:
   • The Court of Protection makes decisions on financial or welfare matters for individuals who lack capacity.
   • The court can appoint deputies to make decisions on behalf of the person.

Safeguarding and Ethical Considerations

1. Safeguarding:
   • Be vigilant for signs of abuse, neglect, or exploitation.
   • Follow safeguarding protocols to protect vulnerable individuals.
2. Ethical Considerations:
   • Respect the dignity and autonomy of individuals.
   • Ensure decisions are free from bias and discrimination.
   • Maintain confidentiality and privacy.