1.1 Assessing mental capacity
There are a number of steps involved in a mental capacity assessment. These are shown in the box below.
Box 1 Five key steps to assessing mental capacity
- The starting point – the principles of the presumption of capacity and respecting a person’s entitlement to make unwise decisions with capacity are the starting point for any capacity assessment.
- Capacity is decision and time specific – saying that someone lacks capacity is meaningless. You must ask yourself: “what is the specific decision that needs to be made at this point in time?” If you don’t define this question before you start undertaking the assessment, the exercise will be pointless and may lead to the wrong outcome.
- Preparation for capacity assessments – remember that a crucial step of assessing capacity is to prepare yourself for the assessment. Don’t go in with a blank canvas.
- Take all practicable steps – you have to ask yourself if there is something that you can do which might mean that an individual would be able to make the decision for themselves.
- Applying the test – the MCA test for capacity has two aspects: the diagnostic element (that is, is there an impairment of, or a disturbance in the functioning of, the mind or brain?) and the functional element (is the person unable to make a decision because of the impairment?). Being unable to make a decision means being unable to understand, retain or “use or weigh” information relevant to the decision, or to communicate their decision.
Activity 1 Assessing mental capacity: the first four steps
Watch the 'Assessing mental capacity' video.
Think through how you would apply steps 1 to 4 from the list in Box 1 as if you were doing an assessment of the man’s mental capacity. (You first watched this video in Week 2 in relation to ‘unwise’ decisions.)
You may also wish to use any of the assessment documents that were introduced in Week 2, Activity 2, or use one of those provided on the Mental Capacity assessment tools page of the Social Care Institute for Excellence site.
Work through the first four steps only at this point. You will return to the final step in the following activity.
When you were undertaking the assessment you may have noted that you:
- needed more information or felt uncomfortable balancing the wishes of the man with what you thought might be best.
- needed to protect the individual and could also empower him to make a decision despite the fact that you may have disagreed with it?
- thought that this was a relatively minor decision and making it may not have had too many severe consequences.
In fact, you may have crossed your mind that he actually gained a lot of enjoyment from the purchase of the lottery tickets. How difficult do you think this assessment would be if the situation had more serious consequences?
You now look at the fifth step in this list, which is the two-stage test for assessing mental capacity.