Understanding mental capacity
Understanding mental capacity

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Understanding mental capacity

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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
(Source: Valios, 2016)

Activity 1 Assessing mental capacity: the first four steps

Timing: Allow about 20 minutes

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.)

Download this video clip.Video player: A video about ‘unwise decisions’
Skip transcript: A video about ‘unwise decisions’

Transcript: A video about ‘unwise decisions’

[MUSIC PLAYING]
[BIRDS SINGING]
MAN
Oh.
[SETTING DISH ON TABLE]
WENDY
What do you want for lunch? I'm doing eggs, all right? Are you in a bad mood with me, Raymond? Look, I'll be out of your hair in 10 minutes. Then you'll be rid of me till Monday.
RAYMOND
That'll be nice.
WENDY
Wendy.
RAYMOND
What?
WENDY
That'll be nice, Wendy.
RAYMOND
Oh.
WENDY
It is my name. I'm sure you weren't meaning to be rude. Well, Raymond, it's been a pleasure as always. Have a nice weekend. Yeah.
RAYMOND
Eh, the lottery.
WENDY
Well, seeing as you asked so nicely, how can I possibly refuse?
RAYMOND
Here.
WENDY
Haven't you got anything smaller?
RAYMOND
All of it.
WENDY
Raymond, you only put two pounds a week on the lotto.
RAYMOND
I want 50 lucky dips.
WENDY
50 pounds is a lot of money.
RAYMOND
I know how much 50 pounds is.
WENDY
You can't afford it.
RAYMOND
It's my money.
WENDY
Yeah, but you have to buy food. You have to pay the bills.
RAYMOND
It's my money.
WENDY
I know it's your money, Raymond. But have a think about this for a minute, yeah? Well, what happens if you lose all of it?
RAYMOND
What happens if I win, eh? Yeah. I would be able to afford proper servants then, not pushy girls like you, telling me what to do all the time.
WENDY
I am not a pushy girl. And I'm certainly not your servant. This is madness.
RAYMOND
I am not mad. I'm old.
WENDY
I didn't mean that. I just mean that I've got a responsibility to make sure you're OK.
RAYMOND
To tell me what to do, you mean?
WENDY
All right. You obviously know your own mind-- if you think you can afford it.
RAYMOND
I can afford it.
WENDY
All right. Do what you like. I'm logging this in the book.
RAYMOND
Oh, yeah.
WENDY
I'm not taking responsibility for how you waste your money, Raymond. Spend it how you like.
RAYMOND
I will.
WENDY
Let me tell you this for free. Chucking your money away like this won't make you happy, whatever.
RADIO ANNOUNCER
And the first ball tonight is number four, one of the most frequently selected balls on the Saturday lotto draw, number four.
RAYMOND
Four. Four. Yeah. Got four. [LAUGHS] Yay.
RADIO ANNOUNCER
27.
RAYMOND
27, 27, yeah. There's one, and there. Woo-hoo! Hey, hey! Yeah, yep, yep. Ha! Ooh, another one. There.
RADIO ANNOUNCER
12.
RAYMOND
12, 12. Wait, wait, wait, slow down. Slow down, will you? Eh, four, 27, 12. Yeah, there you go. Ha!
RADIO ANNOUNCER
So tonight's final lotto number is 13. That's 1-3. 13.
[PAPER CRINKLING]
Good luck, everybody.
WENDY
Well, that was a waste of money.
RAYMOND
13, 13-- ah. Come in, number 13. Your time is up. Ha ha! 13 is my lucky number. Ha! Woo-hoo! 13, yes, 13.
End transcript: A video about ‘unwise decisions’
A video about ‘unwise decisions’
Interactive feature not available in single page view (see it in standard view).

You may also wish to use any of the assessment documents that were introduced in Week 2, Activity 2 [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] , 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.

Comment

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.

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