The role of a Relevant Person’s Representative (RPR) is to be an independent and impartial voice working on behalf of the relevant person under a Deprivation of Liberty Safeguards (DoLS) authorisation. They are there to support inclusion, knowledge, rights and promote the person’s voice within the DoLS process, performing a vital safeguarding role to help monitor its application. As part of this role, an RPR should raise a Section 21a challenge to the Court of Protection if the person they are representing voices an objection to DoLS.
Case studies from the field of Mental Capacity.
The Mental Capacity Act (2005) was designed to help protect the rights of some of society’s most vulnerable people. One of the most frequently overlooked elements of the Act is principle #3: the right to make what others may perceive to be an unwise decision.
The diagnostic step is a simple but often misunderstood part of the Mental Capacity Assessment. One of the most common errors is to simply list a medical diagnosis without any explanation of how the diagnosis impacts upon decision-making. However, this link – also known as the causative nexus – is the vital point on which the rest of the assessment is based. It is therefore important to understand exactly why the diagnostic step is important and how to document it properly.
The way professionals document mental capacity tests can vary greatly across the health and care sectors. In some cases, professionals are not yet using the updated assessment format of Functional and then Diagnostic. More worrying still is that in some cases it’s not just the documentation format that varies, but the quality of the content that is recorded.
In this blog, we examine two example assessments, using the case of Dylan to show the impact documentation can have on the outcomes of an assessment.
Mental Capacity case studies help us apply knowledge in action. They can help us visualise scenarios and understand processes, as well as challenges, before considering the who, what, when, where and how.
In today’s blog, we start a series of case studies that explore particular aspects of the Mental Capacity Act within everyday practice. To help us with this, we will draw on familiar characters from the worlds of TV, film and literature that give an array of contexts and presentations.
There are a number of details that need to be established before a mental capacity assessment is carried out. Without this information, the test may not be valid, and the outcome may be challenged at a later date.
There have been a number of high-profile Court of Protection (CoP) cases this year on the subject of DoLS placement and provisions. These cases each raise questions around the least restrictive option for the individual, what classes as ‘best interest’, and what do we mean by proportionate, reasonable and justifiable care.
Over many years of professional practice I have come across a number cases where certain vulnerable individuals have found themselves unable to make a decision, most frequently when they are confronted with a ‘big decision’ of lasting consequence.
While in some cases it can be sensible to put off a decision until more information becomes available, this ‘decision paralysis’ can sometimes have lasting and quite damaging consequences. This is especially true where decision paralysis can lead to delays in treatment or reduce the quality of life of the individual while they mull over their decision.
In our last blog, we considered the complex case of ‘P’ – an individual being assessed for mental capacity with respect to their change in accommodation, as well as their wish to take responsibility for managing their inheritance.
The case study highlighted several major issues in the way the original mental capacity assessment had been completed, including concerns around the lack of support to help P communicate autonomously, and the lack of documentation around P’s condition and capacity.
In this blog, we will work through an example mental capacity assessment for an individual making a complex decision. This case study is based on a real-life example reviewed in the wake of the Covid pandemic. At each stage we will present the information as it was presented to us, followed by specific comment relating to the assessment process and steps that could and in some cases should have been taken to improve the quality of outcomes.