Mental Capacity Act

Purpose of training session To gain a basic understanding of the Mental Capacity Act and how it applies to your role including: The 5 Principles of the act Assessing capacity and who decides Best interest decisions Documenting decisions Independent Mental Capacity Advocates Lasting Powers of Attorney Advance decisions Court of Protection The Public Guardian Criminal offences Where to get more information

Human Rights Act Influences Article 2 - Right to life Article 3 - Prohibition of inhuman or degrading treatment Article 5 - Right to liberty Article 8 - Right to respect for private and family life such as autonomy and self-determination

Impairment or disturbance that affects the way that the mind or brain works 16

Whats in a name? Ability to Make a Particular Decision at the Time it Needs to be Made Act! Mental Capacity Act

Summary – When does the act apply? Is the person 16 or over? Are they in England or Wales? Do they have an impairment? Is the impairment severe enough that it could effect their capacity to make a particular decision at the time it needs to be made? Does their behaviour, previous capacity issues similar to this decision or information available from others suggest that an assessment needs to be made?

The 5 Core Principles of the act 1.A person is assumed to have capacity. A lack of capacity has to be clearly determined Capacity cannot be determined by age, disability or appearance alone

The 5 Core Principles of the act 2.No-one should be treated as unable to make a decision unless all practicable (realistic) steps to help them have been exhausted and shown not to work. 3.A person can make an unwise decision. This does not necessarily mean they lack capacity. 4.If it is determined that a person lacks capacity then any decision taken on their behalf must be in their best interests. 5. Any decision taken on behalf of a person who lacks capacity must take into account their rights and freedom of action. Any decision should show that the least restrictive option or intervention is achieved.

How did you decide? Look at/hear the information Understand the information Remember the information Think about it and weigh it up Communicate the decision

HURBE H ead U nderstand R emember B alance E xpress

Assessment should lead to.. A reasonable belief that someone has or lacks capacity to make the necessary decision at the time that it needs to be made

Who is the assessor and who makes the final decision? It could be you

Complex decisions, consulting others You may need to consult others to help you to make a decision about capacity (but the final decision remains with you)

What decision should you make for someone who lacks capacity? A decision made on the behalf of someone else should always be in their BEST INTERESTS

Best Interests Exercise Favourite colour Holiday destination Place to retire to Favourite meal Resuscitation or not?

Making sure decisions are in the persons best interests Things you may need to consider Equality and Diversity Adult protection Human rights Who you would consult with How you would involve the service user as much as possible

Best Interests Ensure that you do not make assumptions about someones best interests Consider all the relevant circumstances relating to the decision Consider whether the person is likely to regain capacity. If so can the decision or act wait until then? Ensure that you have done whatever is possible to permit and encourage the person to take part, or to improve their ability to take part, in making the decision. Decisions concerning the provision or withdrawal of life sustaining treatment the must not be motivated by a desire to bring about the persons death. Consider the persons past and present wishes and feelings (in particular if they have been written down) Consider any beliefs and values (e.g. religious, cultural or moral) that would be likely to influence the decision in question and any other relevant factors.

Documenting assessments and best interest decisions Do you need a specific form to document capacity issues?

Documenting assessments and best interest decisions Care plans should show that capacity assessments have been made. Records should show in which instances the person may lack capacity. Day to day decisions may not need to be documented. New decisions or more complex issues should be recorded and include

What else does the act say? Independent Mental Capacity Advocacy (IMCA) Service In some cases an IMCA must be appointed. Some people who lack capacity may have no one to support them (other than paid staff) with major, potentially life-changing decisions so the Act creates a service which will represent and support them. The decision must be regarding major medical treatment or accommodation moves. Adult Protection Capacity assessment must be made by referrer first.

What else does the act say? Independent Mental Capacity Advocacy (IMCA) Service Bev Price – Manager of service

What else does the act say? Lasting Powers of Attorney (LPAs) Replace the old Enduring Powers of Attorney in October 2007 and allow people to put in writing who should make decisions for them in the following areas: Health Welfare Property Money

Important safeguards A new Court of Protection Will have the power to make declarations about: Whether someone lacks capacity, Make orders or appoint deputies to act and make decisions on behalf of someone who lacks capacity. On many occasions, there may be other ways of dealing with difficult situations without having to go to Court, such as via existing complaints procedures.

Public Guardian Tel:

What else does the act say? An advance decision Is prepared when a person has capacity It is a decision to refuse specific treatment and is binding (must be written and witnessed if life-sustaining treatment is being refused)

Advance Decision Website

Important safeguards A new criminal offence ill- treatment or wilful neglect of a person who lacks capacity can lead to fines and imprisonment

Copies of the Code of Practice can be downloaded from Hard copies of this publication are available from TSO Tel

For more information Paul Wilkins Mental Capacity Act Implementation Lead and Trainer Department of Adult Social Care Learning, Training and Development Room 500 Old County Hall Truro Cornwall TR1 3AY Tel:

Useful Information 6 Booklets – Making decisions, a guide for………… DoH Training sets: Mental Capacity Act 2005 Order Core set and the one that relates to your work area