1. Assessing capacity in General Practice

2. Aims Brief overview of metal capacity act Become more familiar with assessing capacity in General Practice

3. Mental Capacity Act Devised in 2005 but only became law in 2007 Provides legal framework for acting and making decisions on behalf of individuals who lack the mental capacity to make decisions for themselves

4. Mental Capacity Act The Act also provides a system of rules for assessing a persons capacity to make decisions. In addition it allows people to make advance decisions if they are concerned they may lack capacity at some time in the future.

5. Areas of capacity covered Health and welfare decisions Medical treatment Finances including property Choices about the most appropriate place to live e.g. full time residential or nursing care

6. Essentially … An assumption of capacity until proven otherwise. Clear rules for assessing capacity, taking into account the best interests of person involved. The acceptance that people make unwise decisions without assuming this is because they lack the ability to make decisions.

7. IMCA Independent Mental Capacity Act Advocates. Represent people without capacity, including those who have no one else to do this for them or where there is a dispute by family members regarding medical treatment or care and welfare decisions. Must be involved when person involved is- – Over 16 – No-one other than professional involved in care who can be consulted about best interests – Decision is re: serious medical treatment/consequences, long term NHS or.local authority accomodation (>8 weeks).

8. Assessing Capacity Establish persons age – mostly applies to over 16s. Assume the person has capacity until established that they lack it – Just because someone lacked capacity for a previous decision, doesnt meant they lack capacity for the current one.

9. Assessing Capacity Do everything possible to support the person making their own decision. – Provide relevant info – Communicate in appropriate manner – Make the person feel at ease – Treat a medical condition that may affect their capacity – Involve family/friends/IMCA where appropriate Be aware of right to make unwise decisions – But…beware repeated unwise decisions that leave them at risk of harm, or decisions out of character; should prompt further investigation Apply principle of equal consideration – Cannot be made solely on age, appearance or condition/behaviour

10. Assessing Capacity - The Two Important Questions! Does the patient have an impairment/disturbance of mind e.g. mental illness, dementia, brain damage, intoxification (Can be partial, temporary or change over time) If they dont, cannot lack capacity Does the impairment mean they are unable to make a particular decision? – If temporary incapacity, then if feasible, decision should be delayed – Decision being made should always be the least restrictive of persons freedoms – So to have capacity the person must be able to …

11. Assessing Capacity 1. Understand the information relevant to the decision; Including nature of decision and why needed. 2. Retain that information (long enough to make an effective decision). 3. Use or weigh up information as part of process of making decision. 4. Communicate their decision.

12. Assessing capacity Good record keeping essential – Steps taken in assessing capacity – Assessment of incapacity – Objective reasons to explain why there is reasonable belief that person lacks capacity

13. Other aspects of act Ability to nominate substitute decision- makers under a Lasting Power of Attorney (LPA) The development of a new Court of Protection with extended powers Specific provisions for enrolling incapacitated adults in certain forms of research.

14. Useful references Office of the public guardian – 0845 330 2900 – Guide for public - http://www.bradfordairedale- pct.nhs.uk/NR/rdonlyres/28ADE138-72AE-4A81-87AF- E3A773747CFA/61716/01bookletpublicguide.pdf http://www.ethics-network.org.uk/educational-resources/mental- capacity-act-2005 http://www.ethics-network.org.uk/educational-resources/mental- capacity-act-2005 http://gmc-uk.org/guidance/consentguidance/part3capacityissues.asp http://www.bma.org.uk/ap.nsf/Content/mencapact05?OpenDocument &Highlight=2,mental,capacity