Standard 9 of the Care Certificate is designed to give care workers a basic awareness of the challenges associated with mental illness, dementia and learning disabilities, even if they do not directly work with individuals that have these conditions.
It starts by looking at the needs and experiences of individuals with these conditions before looking at ways to promote their health and wellbeing.
It continues by exploring what adjustments to their care may be needed, the importance of early detection, legal frameworks and mental capacity.
The information on this page has been updated and quality assured for 2023.
Learning Outcomes & Assessment Criteria
- 9.1 Understand the needs and experiences of people with mental health conditions, dementia or learning disabilities
- 9.1a. List how someone may feel if they have: 1. Mental health conditions such as: Psychosis, Depression and Anxiety 2. Dementia 3. Learning Disabilities
- 9.1b. Explain how these conditions may influence a person’s needs in relation to the care that they may require.
- 9.1c. Explain why it is important to understand that the causes and support needs are different for people with mental health conditions, dementia and learning disabilities.
- 9.2 Understand the importance of promoting positive health and wellbeing for an individual who may have a mental health condition, dementia or learning disability
- 9.2a. Explain how positive attitudes towards those with mental health conditions, dementia or learning disabilities will improve the care and support they receive
- 9.2b. Describe the social model of disability and how it underpins positive attitudes towards disability and involving people in their own care
- 9.3 Understand the adjustments which may be necessary in care delivery relating to an individual who may have a mental health condition, dementia or learning disability
- 9.3a. Describe what adjustments might need to be made to the way care is provided if someone has 1. A mental health condition such as: Psychosis, Depression and Anxiety 2. Dementia 3. Learning Disabilities
- 9.3b. Describe how to report concerns associated with any unmet needs which may arise from mental health conditions, dementia or learning disability through agreed ways of working.
- 9.4 Understand the importance of early detection of mental health conditions, dementia and learning disabilities
- 9.5 Understand legal frameworks, policy and guidelines relating to mental health conditions, dementia and learning disabilities
- 9.5a List the main requirements of legislation and policies that are designed to promote the human rights, inclusion, equal life chances and citizenship of individuals with mental health conditions, dementia or learning disabilities
- 9.5b Explain how the legislation and policies listed may affect the day to day experiences of individuals with mental health needs, dementia or learning disabilities and their families
- 9.6 Understand the meaning of mental capacity in relation to how care is provided
- 9.6a Explain what is meant by the term “capacity”
- 9.6b. Explain why it is important to assume that someone has capacity unless there is evidence that they do not
- 9.6c Explain what is meant by “consent”, and how it can change according to what decisions may need to be taken.
- 9.6d Describe situations where an assessment of capacity might need to be undertaken and the meaning and significance of “advance statements” regarding future care
Care Certificate Standard 9 Workbook Answers
This page contains exemplary answers for all the questions in the workbook for standard 9 of The Care Certificate – Mental Health, Dementia and Learning Disabilities.
The blank workbook for standard 4 can be downloaded from the Skills for Care website (PDF format)
Activity 9.1a, 9.1b & 9.1c
Part i) The issues that someone may experience if they have mental health needs, dementia or learning disabilities could be physical, social or psychological and will affect the individual in different ways. Complete the table below to show your understanding of the needs and experiences of people with mental health conditions, dementia and learning disabilities:
List how someone may feel if they have one of the following conditions (this can include physical, social or psychological issues):
- Anxiety – worried, upset, tearful, high heart rate, out of control
- Depression – sad, tearful, unmotivated, tired, suicidal
- Psychosis – confused, unable to distinguish between thoughts and reality, scared, delusional
- Dementia – confused, scared, frustrated, forgetful, angry, upset
- Learning disabilities – frustrated, communication difficulties, unable to understand/comprehend
Explain how each condition may influence a person’s individual care needs:
- Anxiety – requires reassurance, praise and encouragement, medication, specialist support e.g. counsellor, psychologist, cognitive behavioural therapy etc.
- Depression – emotional support, encouragement to participate and maintain relationships, medication, specialist support e.g. counsellor, psychologist, cognitive behavioural therapy etc.
- Psychosis – reassurance, help to recognise delusions, medication, specialist support e.g. counsellor, psychologist, cognitive behavioural therapy etc.
- Dementia – prompting and reminders, support with day-to-day tasks, occupational therapy, emotional support
- Learning disabilities – support with day-to-day tasks, effective communication, positive behaviour management
Part ii) Why is it important to understand that the causes and people’s support needs are different depending on whether they have a mental health condition or dementia or a learning disability?
All individuals are unique, so a persona-centred approach should be used to ensure that their personal needs, wishes and preferences are met.
Mental health conditions can change in frequency and intensity throughout an individual’s life so it is important that they are given the correct support for the challenges that the condition creates at a specific point in an individual’s life. For example, an individual with a new diagnosis of schizophrenia may need constant observation to ensure they are safe, however, their delusions may become more manageable after being prescribed medication and the support they require become minimal. However, if they forget to take their medication, extra support may be needed again.
Individuals with dementia are going to deteriorate over time, so will require more and more support as they approach the end of their lives. Therefore, it is important that their support plans are regularly reviewed and extra support is added when necessary.
Individuals with learning disabilities may have the potential to develop skills over time that will help them to become more independent, so it is important to provide learning opportunities for them.
When working with individuals with mental health conditions, dementia and/ or learning disabilities, your attitude can have both positive and negative impacts. In the boxes below identify one example of a negative attitude and the impacts it may have. Then give an example of how to positively change and the impacts it could have on the individual.
Negative attitude: Assuming that an individual with a learning disability is unable to have any independence and doing everything for them (e.g. cooking, cleaning etc.)
Impacts: The individual will not gain any independent living skills and may lose any independence that they already had. It may also make them feel devalued and affect their self-confidence and self-esteem.
Positive change: Work with the individual to assess what they can and can’t do and encourage them to do the things that they are able to do and support and teach them to do the things that they find difficult.
Impacts: The individual will gain skills and become empowered and more independent in their work, whilst also increasing their confidence and self-worth.
Fill in the boxes below to describe what is meant by the social model of disability and how it supports positive attitudes of workers and person-centred practice.
The Social Model of Disability suggests that rather than a medical condition being the restrictive factor, it is instead society’s attitudes towards disability that are restrictive. This is in contrast to the Medical Model of Disability which suggests the problem is the individual’s disability and the solution is for it to be treated or cured. For example, in the case of an individual in a wheelchair who cannot access the second floor of a government building, the medical model says that the barrier is the individual’s disability, whereas the social model says that the barrier is that the government has not provided the facility for people with wheelchairs to access anywhere above the ground floor.
It supports positive attitudes of workers because it prompts them to look for ways to remove the societal barriers that limit an individual’s life rather than dismissing challenges as something an individual cannot do because of their disability. It also encourages them to see what an individual is capable of rather than what they can’t do. This helps to promote equality.
It supports person-centred practice because it identifies ways of adapting the environment so that an individual has the same opportunities as their peers and their needs, wishes and preferences are taken into account. This shows respect for the individual as well as empowering them to make choices about their lives and promoting independence.
When supporting an individual with mental health conditions, dementia or learning disabilities, changes or adjustments might need to be made to a service in order to provide the best quality of care. In the table below, a suggested adaptation has been included for each condition. Describe what actions should be taken and why it would be useful for the condition.
|Actions to be taken
|What it is and why it would be useful?
|Additional training for workers
|Specific training for the disorder(s) affecting an individual that they support. This could include behaviour management plans and restraint or breakaway techniques. Workers would have an understanding of the reasons of the actions and behaviours of the individual, resulting in increased empathy and the knowledge and skills to support them.
|Access to information such as helplines
|Information and support from a variety of sources including governmental and charity-run. By having the information accessible, the individual will be able to obtain support privately whenever they feel they need it.
|Emotional support provided by workers
|Workers provide an outlet for an individual's feelings and can provide them with information and advice. The individual would receive emotional support, which can help with their wellbeing and build a trusting professional relationship between the individual and the worker.
|Access to support groups
|Support groups consist of other individuals with dementia that are going through similar experiences to the individual themselves and are often led by professionals that have a lot of experience with dementia. Support groups can provide emotional support, empathy, future-planning information and practical advice for managing the onset of dementia. As well as supporting the individual, help can also be provided to others such as the individual's family.
|An occupational therapy assessment
|Occupational therapy assessments look at what an individual is capable of and their potential for learning new skills as well as offering suggestions for adaptations. This can increase an individual's independence which can result in an increased quality of life.
Reporting: Using your own organisation’s agreed procedure (where possible), describe how to report concerns associated with any unmet needs which may arise from mental health conditions, dementia or learning disability through agreed ways of working.
If I had concerns about the needs of any of the individuals that I support not being met then I would report this verbally to my manager immediately as well recording it on my organisation’s computer systems, as per agreed ways of working. I would also write my concerns in our communications book to make other members of the team aware. If my manager did not take my concerns seriously or did not address the issue within a reasonable amount of time, I would escalate my concerns to the senior management team.
An early detection of mental health conditions, dementia or learning disabilities can support an individual to maximise their quality of life. Complete the spider diagram below to list and explain the benefits of early detection.
Benefits of early detection include:
- Individuals can get the right treatment before the condition becomes worse
- Individuals can access the support they may need earlier
- Individuals and their families can plan for the future
- It can remove the stresses associated with the uncertainty of living with undiagnosed symptoms
Care and support might need to be adjusted when mental health conditions, dementia or learning disabilities are identified. For each of the examples below, state how and why care and support might need to be adjusted.
Mental health – anxiety. Rashid suffers from an anxiety disorder called claustrophobia. He is afraid of being in small spaces, which makes it impossible for him to go in a car or a bus or use a lift. Rashid finds using the bathroom challenging at times. Next week he has an appointment he needs to go to.
HOW? Rashid may need extra staffing to support him to attend his meeting. Staff should also ensure he is taking his medication if he has any. The other party/parties of the meeting may need to be informed of Rashid’s difficulties (with his consent) and the venue changed to an outdoor location or large room. It may also need to be a local venue that is within walking distance. Another option is that the meeting could take place in his home.
WHY? The appointment may be related to Rashid’s health or welfare and so it is important that he attends and receives the support he needs to do this.
Dementia. Paul has difficulties with activities such as preparing meals and eating regularly. This is because he loses track of time and forgets what time he needs to eat.
HOW? Staff could be made available at meal times to remind Paul to eat and help prepare meals. Alternatively, Paul could use reminder systems such as alarms or post-it notes to help him remember.
WHY? If Paul does not eat regularly, he will become malnourished over time, which can lead to other illnesses and a deterioration of his health and well-being. Using reminders will allow Paul to maintain his independence with regard to preparing his own meals.
Learning disability Eliza is living with Down’s Syndrome and is finding it difficult to communicate verbally with others around her.
HOW? Staff should work with Eliza to establish her preferred methods of communication and the staff team should be trained in their use. Eliza may wish to develop other communication skills such as Makaton alongside her staff team.
WHY? Communication is very important for individuals that are receiving care because it enables them to express their needs, wishes, preferences and feelings. If they are unable to do this, they will not be able to actively participate in their care and this can lead to a deterioration of their quality of life.
Activity 9.5a & 9.5b
There are a number of pieces of legislation and polices that have been developed to promote the human rights, inclusion, equal life chances and citizenship of individuals with mental health conditions, dementia or learning disabilities. Complete the table below that identifies four examples of legislation and policies, along with their main requirements and how these can influence the day-to-day experiences of individuals with mental health conditions, dementia or learning disabilities and their families. Examples have been started for you to complete.
The Human Rights Act 1998
This Act sets a number of basic human rights that all people have, including the right to life, the right to freedom from torture and degrading treatment, and the right to respect for private and family life.
Individuals can expect to have their human rights respected and they are protected by law from anyone that may try to take away their liberties and freedoms.
Mental Capacity Act 2005
This act is designed to protect individuals that do not have the capacity to make decisions for themselves by setting out the criteria that assess whether an individual has the capacity to make a choice.
Individuals can only be restricted in making decisions after being assessed and any decisions made about them must be made in their best interests.
Data Protection Act 2018
This act ensures that those who hold personal information (such as companies, organisations and public bodies) keep it confidential, accurate and only as long as necessary.
Personal data can only be shared on a need-to-know basis and with the individual’s consent. It should also be stored on secure systems.
The Care Act 2014
This act puts the responsibility on local authorities to ensure the well-being of their community by identifying individuals with care needs, assessing them and providing services. It has a focus on prevention, which includes having accessible information and advice and services available to delay the impact of an individual’s needs.
This act helps to improve individuals’ independence and well-being, allowing individuals access to the care they need before they develop into more serious needs and access to information to make informed decisions.
In your own words explain what is meant by the term capacity.
Capacity is an individual’s capability of being able to do something and mental capacity is an individual’s ability to make decisions for themselves. To measure an individual’s capacity to make a decision they must be able to understand the information they are given, retain it long enough and be able to weigh up the pros and cons as well as be able to communicate their choice. Mental capacity is assessed on a decision-by-decision basis so an individual may have the capacity to make some decisions but not others.
At times you might be unsure whether individuals to whom you give care and support fully understand the choices they have or what type of support and care they need. Explain why it is important to assume that someone has capacity to make decisions unless there is evidence that they do not.
You should always assume an individual has the capacity to make a decision unless there is evidence to indicate otherwise because preventing an individual from making a choice contravenes their human rights and can take away their independence and confidence, which can also affect their well-being. Even if you do not agree with the choices that an individual makes or believe them to be unwise you should always remember that is the individual’s right to choose.
You will frequently come across the term consent and informed consent when working in health and social care. Answer the questions below to show your understanding of consent.
1.a. What is meant by the term ‘consent’?
Consent means to agree to something. In healthcare, individuals must give their consent or permission for healthcare workers to provide care or treatment.
1.b. What is meant by the term ‘informed consent’?
Informed consent is giving permission to receive care or treatment when all the information about the choice has been provided and there is an understanding of the pros and cons of the decision as well as potential consequences.
2. Write two examples to show how consent may change depending on the decision that is being made:
An individual may consent to their medication being changed without understanding the full implications. When it is explained to them and they are made aware of the possible consequences (e.g. the side effects) it becomes informed consent – and they may decide to withdraw consent.
An individual may provide consent in day-to-day life, such as by opening their mouth when being fed or taking their shoes and socks off when a professional asks if they can trim their toenails but for more complicated choices such as surgery that have associated risks they would need to understand the full ramifications. If they are unable to understand due to diminished capacity, a decision would need to be made for them in their best interest.
Complete the boxes below to describe where an assessment of capacity might need to be carried out and describe the meaning and significance of ‘advance statements’ or ‘advance care planning’ regarding future care.
An assessment of capacity might need to be carried out where there is doubt that an individual can understand the information provided to them about a decision and retain it long enough to weigh up the options. An assessment may also be required if an individual is unable to communicate their decision.
Advance statements (or plans) are very important and significant for future care because they allow individuals to make decisions for their future at a time when they have the mental capacity to do so. This ensures that the individual will receive the care that they wish at a time when they may not have the mental capacity to make the choices.