Being in control of my choices Martin Watson Mental Capacity Act Project NHS Birmingham South Central CCG

When you are faced with an important decision, how do you decide? Do you talk to people close to you? Do you look for information?

Have you heard of the Mental Capacity Act? What does this mean for you and your family?

The Mental Capacity Act The Mental Capacity Act is often referred to as the ‘MCA’ We have the right to make our own decisions Our choices must be respected, we have the right to decide where we live, what medical treatment we have or don’t have and what care and support we receive, for example The MCA protects people’s right to make their own choices The MCA gives people ways that they can plan ahead for the future, for if there may be a time when they cannot make choices for themselves because of illness or disability The MCA provides a framework for making decisions for people cannot make choices for themselves because of illness or disability

Dennis is 90 years old, he has fallen over and needs an operation, he has got dementia and doesn’t understand the decision, who makes the decision if Dennis cannot make a decision for himself?

If a person cannot make a decision due to illness or disability Mental capacity refers to a person’s ability to make a decision, at the time that decision needs to be made When a person is said to ‘lack mental capacity’ they are unable to make an informed decision because of an impairment in the functioning of their mind or brain – they cannot give valid and informed consent If a person is assessed to lack mental capacity to make a specific decision, that decision is made on their behalf in their best interests by the appropriately qualified professional – not Next of Kin Best interests decisions are person centred, it is all about the person who lacks mental capacity and what is important to them, it should meaningfully involve them and the people important to them

Health Preferences Home Family The person should be at the centre of everything that we do There are other advance expressions of wishes and person-centred planning tools, such as: Living wills About Me My Hospital Book

Advance Care planning It’s all about you having as much control over your care and treatment as possible ‘My Care’ book – This helps everyone to know the things that are important to you so that you can be given personalised care and support How you like to be cared for Where and when you do and don’t receive treatment If you do or don’t want to be admitted to the hospice Knowing what’s important to you, and what your unique values, wishes and beliefs are means that decisions can made that are person centred if there is every a time when you can’t make a decision or tell people what you want and what is important to you

Should we be able to plan ahead for a time when we might lack mental capacity to make important decisions? How should we do this?

Advance Decisions If you are 18 years old and above: You can write an Advance Decision to refuse treatment You must have mental capacity to make the decision at the time you write an Advance Decision This is valid even if you lack mental capacity for some reason at some point in the future You can only refuse specific treatment, you cannot demand treatment You cannot refuse basic or essential care My choices for the future X No thank you Yes please

Advance Decisions If the Advance Decision concerns life sustaining treatment, it must be written, witnessed, signed and must include a clear specific statement that you would refuse the treatment even if your life were at risk There are times when Advance Decisions don’t apply under Part IV of the Mental Health Act where compulsory treatment can be given regardless of whether the person has or doesn’t have capacity to consent as different safeguards apply YOU ALWAYS HAVE THE RIGHT TO CHANGE YOUR MIND! My choices for the future X No thank you Yes please

Lasting Powers of Attorney (LPA) Attorney $ If you are 18 years old and above: You can register a Lasting Power of Attorney to give someone you trust, the legal authority to make decisions on your behalf You must have mental capacity to make the decision about registering a Power of Attorney at the time of making the decision The Lasting Power of Attorney remains valid even if you lack mental capacity for some reason at some point in the future Attorneys have to act in the best interests of the person

Lasting Powers of Attorney (LPA) Attorney $ If you are 18 years old and above: A Lasting Power of Attorney must be registered with the Office of the Public Guardian (OPG) in order to be valid There is a cost for registering a Lasting Power of Attorney, this is currently £110 (there are some exemptions if you are on certain means tested benefits and the fee is reduced by 50% if your income before tax is less than £12,000) - if you ask for a Solicitor to help you register it they may charge you for their time / service

Lasting Powers of Attorney (LPA) Property and Affairs: Can manage any aspect of the person’s finances and property Can be a family member, friend or someone the person trusts, such as a solicitor (who may charge for the service) Nominated by the person themselves when they have capacity to decide to have an attorney Can be used when the person still has capacity or when they lose capacity (this is up to the person registering the LPA) $ Attorney

Health and Welfare: Can make decisions about the person’s accommodation, care and treatment Can be a family member, friend or someone the person trusts, such as a solicitor (who may charge for the service) Nominated by the person themselves when they have capacity to decide to have an attorney Can only be used when the person lacks capacity to decide, if they have capacity they must decide for themselves An attorney cannot consent or refuse treatment for a mental disorder for a patient detained under the Mental Health Act Attorney cannot agree to or refuse life-sustaining treatment unless the LPA specifically gives the Attorney this power Lasting Powers of Attorney (LPA) Attorney

You can contact the Office of the Public Guardian (OPG) to find out if there are any registered Powers of Attorney: You can contact the Office of the Public Guardian (OPG) if you have concerns about an attorney or deputy (as well as submitting a multi-agency safeguarding alert): Government Web Portal for an overview of Lasting Powers of Attorney: Information about Advance Decisions to Refuse Treatment:

Thank you for your time For further reading and information please take an information handout