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Understanding mental capacity
Understanding mental capacity

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3.2 Advance decisions

When a person has lost mental capacity, it can be difficult to be sure what their intentions were when they did have capacity. Mental capacity assessments explore these issues in detail, to achieve the most accurate possible interpretation of wishes and feelings.

When a person’s mental capacity is intact, they can state their wishes in order to guide decisions should they lose capacity in the future. This is known as making a statement of ‘advance decisions’.

In the next activity, you hear from Lesley, who discusses her advance decision in relation to her long-standing mental health problems.

Activity 8 Lesley’s advance decisions

Timing: Allow about 30 minutes

Lesley Murray has had bipolar affective disorder for many years. This has meant that she has often temporarily lost the capacity to make decisions for herself.

In the video you hear Lesley talking about how, since her diagnosis, she has made a statement of advance decisions. This has helped put her illness and its management in better perspective, and she feels that she is now much more in control in the long term should things deteriorate again. 

Watch the Mental Welfare Commission for Scotland video [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] (can be found here on Vimeo) of Lesley talking about her advance decisions statement. Think about the deterioration in Lesley’s mental state and what might have helped her to make longer term decisions.

Now look at one of the following documents. You may choose to look primarily at a version that relates more to a UK nation that is of particular interest to you, rather than at all three options.

How might such a statement have benefited Catherine, the lady with dementia in Activities 6 and 7? Write your ideas in the text box below.

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Catherine’s situation is perhaps less clear cut than Lesley’s. Lesley is younger and has lost and gained mental capacity a number of times. She might find it easier to contemplate her future than Catherine. We don’t know much from the case study details, but Catherine’s mental deterioration may have been gradual and accompanied by diminishing contact with her few remaining relatives. There may have been no one around to discuss longer term arrangements that take account of her advancing years and declining capacity.