1.1 The Mental Capacity Act 2005
The Mental Capacity Act 2005 details certain principles or guidance by which capacity should be assessed. It states how managing a cared-for person’s capacity must be carried out.
These principles are summarised below.
- Capacity must be assumed, unless a lack of capacity is established (i.e. the starting point is to assume that someone is able to make decisions).
- A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success.
- A person is not to be treated as unable to make a decision merely because they make an unwise decision.
- Any decisions or actions made related to capacity must be in the cared-for person’s best interests.
- Any decisions or actions taken related to capacity must be achieved in a way that is least restrictive of the person’s rights and freedom of action. (You learn more about least restrictive practice later in this section.)
To help you understand how the principles are applied, read the brief case study below. Would you conclude that the person at the centre of the case study, Desmond, has capacity or lacks capacity?
Case study: Desmond
While out shopping, Desmond collected his pension and gave half to a Big Issue seller. He then found and wore a colourful hat, which he wore to the supermarket where he bought some processed food and enjoyed a strong coffee with four sugars.
Later that day, a neighbour told Desmond’s daughter that he should not be allowed out by himself as he had made a fool of himself and clearly was unable to look after himself properly.
It seems that the neighbour who witnessed Desmond’s behaviour earlier that day assumed he was not able to look after himself as he should. You might argue about how wise Desmond’s decisions were, but they do not necessarily demonstrate lack of capacity to make decisions. At this stage, no attempt had been made to ascertain if Desmond was able to understand any concerns about his behaviour, retain information about any concerns, think through why his neighbour was concerned or communicate his own views on what he was doing.
Placing restrictions on Desmond’s trips to town would not necessarily be acting in his best interests as it would deprive him of the opportunity to act independently and stop him doing what he wanted. If his daughter and others continued to have concerns about Desmond’s behaviour they could ask for an assessment of his capacity.
You learn more about assessing capacity in the next activity.
Read the case study and then answer the questions that follow.
Imagine that your friend Kevin calls round to ask you to help him take his wife, Caroline, to hospital for an appointment at a memory clinic. He says that Caroline is now objecting to going to the hospital and Kevin feels that if you accompanied them she is more likely to go. When you meet Caroline at their house you find that Kevin has already taken the car out of the garage. He recounts how he helped Caroline wash, and choose appropriate clothing and dress, saying that in each of these activities he reminded her about her appointment at the memory clinic.
Kevin reminds Caroline again as he helps her put on her shoes and a coat. You note how he gently reminds her about going to the hospital and how long it will take. You suggest that they might go for a coffee afterwards.
1. In what ways do you think Caroline’s capacity might be affected?
As the appointment is at a memory clinic, it is likely that Caroline is experiencing memory problems. If she has difficulty with her short-term memory she may be unable to retain information about the hospital appointment. Caroline’s ability to understand that she has the hospital appointment and why she has the appointment is probably impeded, and she may object to going to the hospital clinic.
2. What support might you offer Kevin?
You could note how Kevin patiently takes practicable steps to help Caroline understand and attend the appointment. For example, Kevin repeats the information about the hospital appointment several times. It might be that you can repeat to Caroline the information Kevin has already given her and hold her hand, perhaps while Kevin prepares to get in the car. Comforting words, perhaps, would help reassure Caroline that where she is going is in her best interests.