Mental capacity assesments and advance statements

Describe situations where an assessment of capacity might need to be undertaken and the meaning and significance of “advance statements” regarding future care

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A mental capacity assessment (MCA) may need to be performed if an individual has demonstrated that they are unable to make decisions for themselves. For example, if an individual is unable to manage their finances so that their rent and bills are paid, it may mean that they require an MCA around their finances or if an individual requires surgery but it is thought that they do not fully understand the potential risks and complications, again an MCA may be performed.

It is important to understand that an MCA will only cover one aspect of an individual’s life. For example, if an individual has an MCA for their finances, that doesn’t mean that they are unable to make other decisions such as what to eat or what time to go to bed. Similarly an MCA should only last for as long as needed or in certain circumstances. It may be an individual can make decisions when they are regularly taking their medication but lack the capacity when they stop taking it.

The two specific questions to ask that are useful for assessing an individual’s capacity are:

  1. Does the person have an impairment, or a disturbance in the functioning, of their mind or brain? This can include, for example, conditions associated with mental illness, concussion, or symptoms of drug or alcohol abuse.
  2. Does the impairment or disturbance mean that, even when given appropriate support, the person is still unable to make a specific decision when they need to?

And the Mental Capacity Act 2005 states that an individual is only able to make a decision if all of the following are true:

  • Can they understand the information given to them?
  • Can they retain the information long enough to make a decision?
  • Can they weigh up the information given in order to make a decision?
  • Can they communicate their decision?

Care workers should always attempt to find ways to enable and empower an individual to make their own decisions. For example, an individual may not be able to understand the information to make a decision if it is written down (perhaps they are unable to read) but may be able to do so if it is explained to them verbally. An individual that has severely restricted movement may not be able to communicate their decision verbally but may be able to communicate by blinking their eyes.

There are five key principles that must be followed when assessing an individual’s capacity. They are:

  1. Always assume that an individual can make their own decisions.
  2. Ensure all possible support is provided to make sure that an individual can make their own decisions.
  3. Do not assume an individual is unable to make a decision because you believe that their decision is unwise or unsafe.
  4. If it has been identified that an individual cannot make a decision, then whomever makes the decision on the individual’s behalf must do so in their best interests.
  5. When somebody else makes a decision on an individual’s behalf, they must always choose the least restrictive option.

Advance statements (also known as Advance Care Planning) are decisions that an individual makes about their future care and support whilst they have mental capacity to do so. This is especially useful for individuals that have dementia because as they deteriorate they may lose mental capacity and somebody else may be responsible for making decisions about them. With advance statements, they can ensure they have a voice and their wishes are  respected and taken into account when decisions are made about them.

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