1. Mental Capacity
Dan Haworth

2. Aim
Be able to assess a patients mental capacity and integrate it into to a care pathway for that patient.

3. What is it?
The Mental Capacity Act 2005 (the Act) provides the legal framework for acting and making decisions on behalf of individuals who lack the mental capacity to make particular decisions for themselves. (Department for Constitutional Affairs, 2005, MCA Code of Practice)

4. The 5 statutory principles
A person must be assumed to have capacity unless it is established that they lack capacity.
A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

5. This checklist is a summary of points to consider when assessing a person’s capacity to make a specific decision.
Presuming someone has capacity
The starting assumption must always be that a person has the capacity to make a decision, unless it can be established that they lack capacity.
Understanding what is meant by capacity and lack of capacity
A person’s capacity must be assessed specifically in terms of their capacity to make a particular decision at the time it needs to be made.
Treating everyone equally
A person’s capacity must not be judged simply on the basis of their age, appearance, condition or an aspect of their behaviour.
Supporting the person to make the decision for themselves
It is important to take all possible steps to try to help people make a decision for themselves.

6. Assessing Mental Capacity
Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (It doesn’t matter whether the impairment or disturbance is temporary or permanent.)
If so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made?

7. Lacking capacity
A person lacks capacity if: • Unable to make decision • Because of impairment of or disturbance in functioning of, the mind or brain. A person is unable to make a decision if unable to: • Understand the relevant information • Retain the information • Use the information to make the decision • Communicate the decision

8. Best interests
• Will the person regain capacity and when? • Permit and encourage the person to be involved as fully as possible. • Consider the person’s past and present wishes, beliefs and values, other circumstances she would be likely to consider. • Take account of the views of anyone engaged in caring for him/her or interested in her welfare.

9. Restraint • Two additional conditions: • Restraint:
Must reasonably believe that it is necessary to prevent harm to the Person.
Must be proportionate to the likelihood and seriousness of the harm.
• Restraint:
Use or threat to use force to secure the doing of an act which the person resists or
Restrict liberty of movement whether or not person resists