Mental Capacity Assessments are not the same as as an assessment of cognition
Many families find that decisions are made about vulnerable older relatives without a proper Mental Capacity Assessment being carried out. It seems there is also sometimes little consultation with the person in care or their representative.
Many people are confused about what a Mental Capacity Assessment (MCA) actually is – and when it should be used. This article aims to make that clearer.
We’ve also included links to some news articles and case studies to show how Mental Capacity Assessments should work, and how they relate to Best Interests meetings and Deprivation of Liberty Safeguards (DoLS).
What is mental capacity?
When a person has ‘capacity’, they have the ability to make a specific decision for themselves – at the time the decision needs to be made. A person who lacks mental capacity does not have this ability.
The Mental Capacity Act (2005) is the legislation that governs this. Essentially, it’s about protecting a person’s right to decide what happens to them, and this is particularly pertinent to a care situation, of course.
If a person can’t make a specific decision or give consent to something, the legislation is supposed to ensure any actions subsequently taken by other people are in the person’s best interests.
However, reports from many quarters including the Care Quality Commission, indicate that many people working in health and social care often lack vital knowledge and training about this, and this can lead to decisions being made about a person without the proper process being followed, without the proper safeguards being adhered to – and without it all being properly documented.
If a person’s ability to make a decision about something and/or give consent to something is in doubt, a Mental Capacity Assessment should be undertaken.
It may be easier to understand Mental Capacity Assessments by looking at what they’re not:
- A Mental Capacity Assessment is not about a person’s general cognitive ability or the extent of a person’s memory. Instead, broadly speaking, it looks at whether that person can make a specific decision about a specific thing at a specific time.
- A Mental Capacity Assessment is NOT the same as a memory test or cognitive test (sometimes referred to as an MMSE or an ACE-R test).
- A Mental Capacity Assessment is not used for scoring the care needs in the Cognition domain in an NHS Continuing Healthcare funding assessment.
- A Mental Capacity Assessment is not a statement of a person’s ability to make decisions in the future. It’s about a decision that needs to be made now. Capacity can also fluctuate; for example, a person’s ability to make a decision about something now may not be the same in a few weeks’ time.
This two-page leaflet from Woodfines Solicitors summarises the key questions a person should be asked in a Mental Capacity Assessment.
In what context is a Mental Capacity Assessment used?
These are just a few examples:
- decisions about going back home after discharge from hospital
- decisions about where a person will be cared for, e.g. at home, in a care home, etc
- decisions about what care will be provided
- decisions about whether a person should be restrained from going out, e.g. having the freedom to walk in and out of a care home
- decisions about taking prescription drugs
- decisions about covert medication
- decisions about the use of bedrails
…and so on.
This is just a very brief overview to highlight some of the basics. The articles below go into much more depth and also highlight specific cases:
Cambridge News: The case of a man who was moved away from his family without the proper assessments being done and with his family’s wishes ignored and without proper records being completed
Stowe Family Law: The Ombudsman’s declaration that capacity assessments need to be formally recorded/documented.
Quality Compliance Systems: A good overview of the whole topic
Community Care: Restricting a person’s liberty falsely: Lack of attention to Mental Capacity Assessments and correct Deprivation of Liberty Safeguards by care providers
Community Care: More on Deprivation of Liberty – and the issue of whether a person has ‘freedom to leave’
Community Care: More on Deprivation of Liberty – forms, checklists, paperwork, and safeguarding the person at the centre of the process
Also remember that, in all this, if you’re acting on behalf of a relative a power of attorney is vital. Read more about powers of attorney.