1. Mental Capacity 23 rd Sept Matt O’Connor –Safeguarding Lead B&AtPCT

2. Mental Capacity Autonomy and right to self-determination Self Advocacy Protection Prevention of neglect Public and family expectation It all hinges on capacity! Respect decisions where person has capacity You make best interest decision for people who lack capacity

3. Assessing Mental Capacity (‘Process’ or ‘Functional’ approach) People have the right to accept or refuse care or treatment if they can understand the information retain the information weigh up information to make a decision express their choice. Impairment of or disturbance in the functioning of the person’s mind or brain Lack of capacity must be as a result of Impairment of or disturbance in the functioning of the person’s mind or brain

4. MCA (2005) Statutory Principles Summary Everyone must be presumed as having capacity unless established otherwise. Everyone must be presumed as having capacity unless established otherwise. Right to have support to achieve capacity and make your own decision Right to have support to achieve capacity and make your own decision Right to make what might be seen as eccentric or unwise decisions Right to make what might be seen as eccentric or unwise decisions Action can be taken in a person’s ‘Best interests’ where they lack capacity Action can be taken in a person’s ‘Best interests’ where they lack capacity The action must be the least restrictive intervention possible The action must be the least restrictive intervention possiblehttp://www.dca.gov.uk/menincap/bill-summary.htm

6. Advance decisions to refuse treatment Allows people to refuse specified medical treatment in advance. (If valid, has same legal standing as when person has capacity) Allows people to refuse specified medical treatment in advance. (If valid, has same legal standing as when person has capacity) Previously called ‘living wills’ or ‘advance directives’ Previously called ‘living wills’ or ‘advance directives’ Must be made when a person still has capacity. Must be made when a person still has capacity. It must be clear about which treatment it applies to and when and must be in writing and witnessed if it applies to life-sustaining treatment. It must be clear about which treatment it applies to and when and must be in writing and witnessed if it applies to life-sustaining treatment. You cannot make an advanced statement to insist on treatment You cannot make an advanced statement to insist on treatment Advanced statements describe wishes. They should be used to inform best interest decisions. Advanced statements describe wishes. They should be used to inform best interest decisions.

8. Lasting Powers of Attorney (LPA) The Act enables people to appoint someone they know and trust to make decisions on their behalf for a time when they may lack capacity. This is called the ‘Lasting Power of Attorney’ There are two types of LPA – ‘Property and affairs’ – ‘Personal welfare’ N.B Old Enduring Power of Attorney does not give any power to make healthcare / welfare decisions on behalf of someone else

9. Lasting Powers of Attorney cont. A person can only make an LPA when they have capacity A person can only make an LPA when they have capacity An LPA must be registered with the Public Guardian An LPA must be registered with the Public Guardian When the person looses capacity, their proxy assumes the power to accept or refuse treatment on behalf of the person. When the person looses capacity, their proxy assumes the power to accept or refuse treatment on behalf of the person. The chosen attorney must act in the person’s best interests. The chosen attorney must act in the person’s best interests.

10. IMCA’s are appointed where people who have no friends or family with whom it is practicable to consult IMCA’s are appointed where people who have no friends or family with whom it is practicable to consult IMCAs do not have powers to make decisions but do advocate for and support the person in the decision making process. IMCAs do not have powers to make decisions but do advocate for and support the person in the decision making process. An IMCA must be consulted for decisions about. An IMCA must be consulted for decisions about.  serious medical treatment  hospital stay for 28 days or more  accommodation change for 8 weeks or more The Independent Mental Capacity Advocate (IMCA)

11. IMCA referral Contact details for the IMCA service are: Learning disability: CHOICE Advocacy telephone 01274 731522 Learning disability: CHOICE Advocacy telephone 01274 731522 Mental health: BAMHAG Mental health: BAMHAG telephone 01274 770118

12. Final points Use the MCA Code of Practice! Use the MCA Code of Practice! Use the MCA Code of Practice!! Use the MCA Code of Practice!! Use the MCA Code of Practice!!! Use the MCA Code of Practice!!!