Assessment + Evaluation

Definition: 'Mental capacity' means being able to make your own decisions

(Mental Health Foundation, 2019).

The following principles apply for the purposes of this Act:

1. A person must be assumed to have capacity, unless it is established that he/she lacks capacity

2. A person is not to be treated as unable to make a decision unless all practicable steps to help him/her to do so have been taken without success - e.g. different methods of communication/language

3. A person is not to be treated as unable to make a decision merely because he/she makes an unwise decision

4. An act done or decision made under this Act, for or on behalf of a person who lacks capacity, must be done or made in his/her best interest

5. Before the act is done or the decision is made, regard must be given as to whether the purpose for which it is needed can be as effectively achieved in a way that is least restrictive of the person's rights and freedom of action

• Any professional caring for or supporting a person who may lack capacity could be involved in assessing capacity (however check Trust guidelines)

• The MCA is designed to empower those in health and social care to do capacity assessments themselves, rather than rely on expert testing by psychiatrists or psychologists

• However, in cases involving complex or major decisions, you may need to get another professional opinion. This could be a general practitioner (GP) or a specialist, such as a consultant psychiatrist or psychologist (SCIE, 2019)

Gain an understanding of the 4 principles:

• Do they understand the decision?

• Are they able to communicate the decision (consider the assessment to be in their language or preferred method of communication)?

• Can they retain information in regards to the decision?

• Are they able to weigh up pros and cons of the decision made?

• Remember: each assessment is decision specific. Capacity is decision specific, so ask questions surrounding this topic only; for example, in regards to discharge destination from hospital

• Know your patient; take a holistic approach

• Are you the best professional to discuss the 4 principles? Is another professional better suited to complete the capacity assessment? Could a joint capacity assessment be completed?

• Give the patient the best possible opportunity; e.g. involve a carer/family member/translator if required

• Write as much evidence as possible to support why a patient lacks capacity

• Medications management - e.g. due to limited finger dexterity, patient stated this has been a problem for them; 'power phrase' this back and state that you previously stated you were limited with your finger movements, so which activities does this limit you with?

• If individual lists activities, then ask how they would manage with those when not in hospital?

• Does the patient have insight into equipment being needed - are they aware they are on the ward? Ask how they will get to the bathroom at home, to see if they have insight to the fact that they need assistance. How will the patient transfer/mobilise to the toilet in between care calls?

• If the patient has 4 care calls, is the patient aware of how they would manage in-between those care calls?

• Consider how the patient would have drinks/snack/medication/pressure relief/ how they would call for help if needed?

• Can they use a phone or pendent alarm?