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Mental Capacity Assessments: Where to start?

Elderly lady walking outside arm in arm with nurse. Photo by Cristina Serí on Unsplash.

From talking to colleagues, team members from different settings and other professionals across the board about the topic of the Mental Capacity Act and its Assessment, one of the most common stumbling blocks reported appears to be – where to start with an assessment, closely followed by the contents of completed assessments. It can leave some people feeling really overwhelmed and unsure of themselves, while others are thriving at the challenge, identifying ways to establish a “standard” for their own working environment. 

Both of these challenges can be addressed through preparation prior to the assessment, which is where this blog and some of our associated pages, resources and training packages may be able to help.

Anyone can complete a Mental Capacity Assessment and it is far simpler than you think, so please do not be discouraged or overwhelmed. As with many things in the world, preparation is key, so start with identifying what the decision is being addressed. If a single word or two are used, this can make it too vague and unclear. Be specific and imagine you are a professional visiting or family member reading the assessment. Ask yourself, would it make sense to them? An example of one might be; Mental Capacity to consent to photos being taken for use in medical charts and displays inhouse. This is specific and to the point, addressing if the person can give their informed permission for their photo to be taken and used in house for identification, medication charts and display boards.

Understanding context

Next, consider what do you need to know around this specific decision in order to make an informed choice? If we continue with the example of photographs for identification, medication charts and displays in house, then the individual would need to know what a photograph is, how it is taken, where it is stored, where it would be used, why it would be used and who might see it. These are our key points that can then be expanded into questions. It is key here to keep to the topic at hand and not to deviate into looking beyond this specific decision.

By expanding these key points into key questions it helps us to look at understanding of this specific decision being addressed. To support this, I would write down in a list or create a flow chart or mindmap. The format is not too important, it is about supporting you to do the assessment., so do what works for you. So if you prefer to type, write, bullet point, map ideas or otherwise, do what works for you. My questions for this decision we are following might include:

  • Have you had your photograph taken in the past?
  • What was it used for?
  • How did they take your photo?
  • What did they do with your photograph – did it need developing or did it go onto a computer for printing etc
  • Where do you keep your photographs – frames on the wall, albums, on electronic devices etc
  • Who might have seen these photos?

I would then provide the individual with information about how we take photographs in that specific setting and compare it to what they have shared, giving clear facts about each area. After which I would ask the individual if they could put it into their own words. This is just one simple way of considering retention of relevant information for this specific decision. If unable to, I would give further information in a graded format, being asking additional questions around this topic:

  • How do we take photographs here?
  • What would we use your photograph(s) for?
  • Where would we store your photograph(s)?
  • Who might see your photograph(s)?

Supporting the individual

Looking at these basic questions around the decision, I can see we have some foundation questions for the decision. Next steps for planning is how to support the individual to weigh up the decision? This is done by grading questions that will prompt reflection on the pro’s and con’s of the decision, so stop to think about any risks of benefits around the decision, remembering we can provide information during this assessment. Any information provided must be checked for understanding and retention – ask what the individual to put it in their own words or what they understood from what has been shared. My questions might include the following:

  • What might be a  benefit of having your photograph in the medication file?
  • What might be a risk or disadvantage if it was not there?
  • What might be a  benefit of having your photograph on your care plan for identification?
  • What might be a risk or disadvantage  if is not here?
  • What might be a benefit of having your photograph on the display boards for days out, events etc?
  • What might be a risk or disadvantage if it is not there?

Remember these questions are not exhaustive, this is just the plan, our outline for the assessment, so when speaking to the individual, we may need to ask more questions if their responses are closed or unclear, grade to give multiple choices or provide visual examples/options to support.

Don’t forget to bring it back to the individual being assessed, how is this decision different in their lives, what communication do they use, how can you grade the questions and resources to support them. Different questions for their situation and individual context(s) might be required, which is what mental capacity assessments can not be standardised for every decision possible.

If your still finding it hard on what to select as questions, don’t forget to sound out with your team, run through an example together to consider each step for that specific decision. Through multiple inputs using reflective practice, it should produce a more cohesive well rounded starting point for questions. On top of which it can build confidence, knowledge and communications within the team through a team task to prepare.

Alternatively, for more complex decisions, is there a suitable professional to request support from or a paid independent assessor or consultant?

Please do keep an eye out for our upcoming blogs, which will include looking at the assessing itself and much more.

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