1. PRACTICAL STEPS TO USING THE MENTAL CAPACITY ACT Dr Mohan Mudigonda Professor Peter Bartlett

2. AGENDA What is capacity? Mental Capacity Act – brief overview Advance Planning and current options – Advance Decisions to Refuse Treatment – Advance Statements – Lasting Powers of Attorney Advance Decisions and the Mental Health Act Everyday tips for finances Q and A

3. WHAT IS CAPACITY ? The ability to reach a particular decision at a particular time Specific, not general Lack of capacity can be temporary or permanent

4. HOW IS CAPACITY ASSESSED? Understanding information Retaining information Weighing up Communicating decision

5. RELEVANCE FOR BIPOLAR DISORDER Capacity may be lost for periods of time but certainly not for the whole time Mania/ depression may be severe enough to affect capacity but not necessarily Remember – capacity is decision and time specific! It can be planned for!

6. WHAT IS ADVANCE PLANNING? A written/verbal document made to plan ahead for a time when capacity may be lost Allows you to be in control even when you can’t make a decision yourself Not difficult to make but extremely important to ensure they are valid

7. ADVANCE DECISIONS TO REFUSE TREATMENT Allow for the refusal of medical treatment in particular circumstances – Specific medications – ECT Cannot be used to demand/ request particular treatments May be overruled if detained under the Mental Health Act (‘sectioned’)

8. BEST INTERESTS Comes into play when capacity is lost and a decision has to be made on your behalf Not defined completely by law Assessment has to consider: – Wishes and feelings – Beliefs and values held when capable – Opinions of family members – Any written statements?

9. ADVANCE STATEMENTS Help to decide whether a course of action is in your best interests Help you to let people know your wishes and feelings when you cannot express these yourself Not legally binding but could be influential and usually only ignored if they are detrimental to well-being Can cover any topics which you consider important; diet, religious beliefs, practical issues

10. LASTING POWERS OF ATTORNEY Allow you to choose WHO you want to make decisions on your behalf Choose your attorney Complete the paperwork (https://www.gov.uk/power-of-attorney/make- lasting-power)https://www.gov.uk/power-of-attorney/make- lasting-power £110 (sorry!)

11. ADVANCE PLANNING AND THE MENTAL HEALTH ACT Possible complications when detained under MHA (sectioned) ADRTs can be overruled IF related to treatment for mental health i.e. bipolar disorder BUT… ECT cannot be given unless in an emergency Good practice dictates that wishes should be respected unless no alternatives are available Advance Statements will be useful

12. EVERYDAY TIPS FOR FINANCES Keep family and friends involved (triggers/ symptoms to look out for) Limiting overdraft facility Withdrawal limits Joint accounts with two signatures Credit cards Remember – unwise decisions do not necessarily mean a lack of capacity!

13. Many thanks for listening! Dr Mohan Mudigonda: m.mudigonda@nhs.net Professor Peter Bartlett: peter.bartlett@nottingham.ac.uk peter.bartlett@nottingham.ac.uk