Mental Capacity

by | Mar 12, 2024

Guidance:

  • Ensure that all care/ support planning adheres to the underpinning principles of the Mental Capacity Act 2005, including best interest, deprivation of liberty (if a person lacks capacity what steps have been taken to support decision making), power of attorney. For the MCA Code of Practice, please click here.

Principle 1 of the Mental Capacity Act is to assume capacity. Therefore, when carrying out a care and support plan, you are seeking to involvement from the person as much as they can for themselves. If there is doubt that the person is able to make key decisions about their care and treatment, for themselves, then you need to carry out a capacity assessment and may need to actin their best interest.  

A mental capacity assessment needs to be done to establish their capacity to make decisions about their care and treatment, or establish if support is needed  

Here are some examples of the different types of capacity, and the level of detail that is needed in the care plan. 

Has Capacity to make all decisions:

This individual either:

  • Has no impairment of the mind or brain and therefore has full capacity to make decisions and no capacity assessment is required.
  • Has an impairment of the mind or brain, but which does not affect their ability to make decisions, and no capacity assessment is required.
  • Has an impairment of the mind or brain which does affect their ability to make decisions, and a capacity assessment has been carried out which has shown that the person has capacity for the decision(s) in question.

The care plan has been written in line with the wishes and preferences of the individual, who has the capacity to make decisions regarding their health and care decisions and their financial decisions. 

Has Capacity to make some decisions:

The individual has capacity to make some decisions but not others. A Mental Capacity assessment has been carried out in relation to each section of the care plan to determine the areas that they can make decisions for themselves.

The follow areas have been identified for having capacity: x……………………………………………………………………………………………………….

The following areas have been identified for lacking capacity: x………………………………………………………………………………………………….

Or

The individual can sometimes make decisions and sometimes requires decisions to be made on their behalf, following best interest principles.  The factors that cause fluctuating capacity or temporary lack of capacity are: x…………… e.g. dementia, infection, alcohol consumption etc.

To decide if they have capacity to make a decision, care staff and professionals will use the following questions:

  • Can they understand the information related to the decision?
  • Can they remember the information for long enough to make a decision?
  • Can they weigh up or use the information to reach a decision?
  • Can they communicate the decision in any way at all?

If the answer to any of those questions is no, you will need to consider the reason, and decide if the decision can be placed on hold until capacity resumes, or if a best interest decision needs to be made. All decisions will be detailed in the daily notes.

Lacks Capacity to make all decisions:

The individual has been assessed as lacking capacity to make decisions and this care plan has been written on behalf of the individual, in their best interest. The care plan was written with x…………………………….. a family member/ professional. A full Mental Capacity assessment can be found on page x…………

Capacity to Consent to Care and Treatment

Capacity to consent to care and treatment (after this section is completed, please fill out any relevant documents as required such as MCA, BI, DOLS and ask for evidence for LPA if there is one). Keep a copy in the care file.

  1. Was the client able to communicate the information above in their preferred method of communication? Yes / No
  2. Was the client able to process and understand the information that you have shared with them? Yes / No
  3. Is the client able to retain information long enough to make a decision? Yes / No
  4. Is the client able to balance and weigh the information and talk to you about themselves? Yes / No
  5. Does the client have a Lasting Power of Attorney? Yes / No

For:

  • Health and welfare
  • Property
  • Finance

6. Is the client able to make decisions? Yes / No

7. Does the client in need of an MCA assessment? (if have not been assessed and need assessing) Yes / No

8. Is the client in need of a best interest from? Yes / No

Additional Comments: (i.e. where is the legal copy of the LPA kept or information of any previous MCA or pending MCA assessments).

  • Representative names/LPA
  • Contact number address
  • Relationship to the client
  • Is the representative the same as next of kin?
  • Do they live with the client
  • Email address (if they have one)
  • First contact number
  • Second contact number (if applicable)
  • Contact preferences
  • Any further comments