1. The Mental Capacity Act 2005 No decisions about me without me

2. Defining Capacity ‘…a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or disturbance in the functioning of, the mind or brain.’

3. 1.A person must be assumed to have Capacity unless it is proved otherwise 2.A person is not to be treated as unable to make a decision unless all practical steps to help them do so have been taken without success 3.An unwise decision does not in itself indicate a lack of capacity 4.An act or decision made on behalf of a person who lacks capacity must be made in their best interests 5.When a person lacks capacity any act or decision should aim to be the least restrictive option The 5 Principles of the MCA

4. A Person must be able to: Understand the information Retain the information Use or weigh the information Communicate the decision Failure on any one part indicates a lack of capacity to make the specific decision at that particular time Reasonable belief is sufficient Anyone can assess capacity

5. Level 1: Day to day decisions Activities of daily living, observations and simple diagnostic tests Level 2: More complex decisions Invasive procedures, complex diagnostic tests, treatments, self discharge Level 3: Significant decisions Serious medical treatment, long term accommodation changes Levels of Assessment

6. A decision made on the behalf of someone should always be in their BEST INTERESTS

7. Best Interest Decisions Consider if capacity may be regained in the future Consider the patients past and present wishes, beliefs and values Consult people who have an interest in the welfare of the patient Encourage and permit the person to participate Consider less restrictive options Do not base the decision solely on age, appearance or behaviour Do not be motivated by a desire to bring about the persons death

8. Independent Mental Capacity Advocates - IMCA IMCAs referrals must be made when: A person has been assessed as lacking capacity to make a decision about serious medical treatment or a long-term accommodation move and they have no family or friends to consult with Referrals can be made by telephone on 0845 2799019 or referral forms are available on the RCHT intranet or the SEAP website: www.seap.org.uk/imca

9. Deprivation of Liberty Safeguards (DOLS) Must be sanctioned by legal processes Situation and individual specific Degree vs Intensity Restraint Possible Deprivation of Liberty Doors locked but able to go out Doors Doors locked but unable to go out Regular escorted leave Leave No leave or very limited leave Some control exercised Control Extensive control re: care and movement Compromise re: discharge Discharge Carers discharge request refused Periodic restraint Restraint Restrained regularly for prolonged periods Visitors attend during visiting hours Visitors Contact with visitors is severely limited Some choice and control re: lifestyle Lifestyle Limited control over lifestyle *The above is not an exhaustive list

10. What is a Learning Disability? A significantly reduced ability to understand new or complex information and to learn new skills (impaired intelligence), with a reduced ability to cope independently (impaired social functioning), which started before adulthood and has had a lasting effect on a person’s development” Valuing People DoH (200)

11. Health Inequalities and People with Learning Disabilities in the UK 2012 Eric Emerson and Susannah Baines (IHAL).

12. Barriers to Health Care for People with Learning Disabilities Poor and restricted access to mainstream services Poor uptake of health screening Diagnostic overshadowing Inadequate diagnosis and treatment Alien world! unfamiliar Don’t understand what is happening Difficulty with waiting for long periods of time Difficulties with being around lots of people Difficulties with noise Frightened of procedures Bad past experiences

13. What is Autism Spectrum Disorder? Autism is a developmental disorder which affects the brain and can make communicating and interacting with other people difficult. It is life long and affects how the person makes sense of the world around them. People with autism can often have problems in 3 areas Social Communication Social interaction Social imagination (adapted from The National Autistic society - http://www.autism.org.uk/autism)

14. Barriers to health Care for people with Autism Spectrum Disorder. There is high premature morbidity rate and mental health problems amongst this group. Also in everyday health care, they can recover slower from ill health or injury. Hypersensitivity to noise and light – hospital can be unsettling. Difficulty in booking appointments and keeping them. During medical consultations they can have difficulty discussing symptoms and expressing views. A combination of the above can lead adults with autism to avoid GP and not access healthcare or only attend when they reach crisis point.

15. Reasonable Adjustments Reasonable adjustments, adapting regular processes to accommodate the disability. Adjustments may be unique to that person. Equality Act (2010) Easy read leaflets, DVD’s. Longer appointment times. Access to Liaison Nurse Service. Non clinical environment visits. Projects to actively engage people with learning disabilities and or Autism. Listening to carers/including them.