1 Mental capacity
The law says you have to start from the position that everyone has the capacity to make decisions about their lives. Some people are born with limited capacity: through brain damage, for example. Other people lose their capacity to understand information and make decisions about themselves through accident, ill-health or a degenerative ageing process.
To better understand how capacity relates to the caring role, you first look at what capacity is and how it might affect a cared-for person. You go on to learn about how capacity is assessed and then how the caring role might be affected by the cared-for person’s capacity. Your learning from this topic will help you to appreciate how mental capacity and positive risk-taking are linked. For the cared-for person, having the mental capacity to make decisions is an important element in being able to judge exposure to risk.
Reflect on what you know about dementia or another serious health condition, such as a stroke, and make a list of the ways that the cared-for person’s mental capacity might be affected.
A feature of dementia is that the person gradually loses their ability over a period of time to remember and think clearly. Some health conditions such as cardiovascular accidents (strokes) can have the same effect. This, of course, can mean that a person’s ability to understand information and make decisions based on that information is impeded. Mental capacity might affect a cared-for person in a number of ways: for example, they are no longer able to manage their financial affairs, or decide on what to eat or which clothes to wear that are appropriate to the weather.
How capacity is determined is governed by law. The relevant law in Scotland is the Adults with Incapacity (Scotland) Act 2000. At the time of writing, the Northern Ireland Assembly is considering a Mental Capacity Bill. In England and Wales, the Mental Capacity Act 2005 is the primary legislation that sets out what capacity is and how an individual’s capacity is managed.
Crucially, the Mental Capacity Act states that a person lacks capacity if they are unable to make a decision for themselves in relation to a specific matter at a particular time. It acknowledges that the ability to make decisions can change with circumstances. For example, if a person lacks capacity to manage their financial affairs at one time, it should not be automatically assumed that they lack capacity to manage their financial affairs ever again.
A person’s capacity may be permanently affected due to dementia, a learning disability or brain injury. However, it is not associated with any particular condition and is dependent on an assessment being made before any decision about capacity is made. Capacity might also be temporary. An older person might become temporarily confused due to a urinary tract infection, for instance, but then receive treatment and recover and regain their ability to make informed decisions.
In the next part you learn more about the Mental Capacity Act 2005 and how it might protect the cared-for person.