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Case Study

Case studies from the field of Mental Capacity.

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Case study: Mental Capacity Assessment for placement decisions

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.

Read More »Case study: Mental Capacity Assessment for placement decisions
Retaining information: man looking out of window

DoLS placements, best interest and the ‘least restrictive option’

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.

Read More »DoLS placements, best interest and the ‘least restrictive option’
Thinking about the future: Man in glasses looking at reflection in train window

Does a person experiencing decision paralysis lack mental capacity?

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.

Read More »Does a person experiencing decision paralysis lack mental capacity?
Young man in red wheelchair smiling and happy

Preparing questions for a complex Mental Capacity Assessment

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.

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Assessing complex cases: Disabled man using eye tracking software

Mental capacity assessments for complex decisions

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.

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Central Middlesex Hospital, part of London NW University Hospital Trust

Patient dies as NHS Trust fails to comply with the MCA

On the 29th December 2021, Jenny Kitzinger and Celia Kitzinger shared a challenging and troubling case on the website Open Justice Court of Protection.  This case demonstrates the lack of knowledge and application of the Mental Capacity Act (2005) by London North West University Healthcare NHS Trust, who continue to be rated as ‘Requires Improvement’ by the Care Quality Commission. 

In this case, the patient, Mrs W, had her nasogastric tube removed by medical staff on 10th November 2021. Mrs W had previously assigned the role of Lasting Power of Attorney (LPA) for Health and Welfare to her children. However, her children were not consulted in this process, and the clinicians declined to reinstate the feeding tube when challenged. The Trust then proceeded to withdraw hydration from Mrs W as well.

Read More »Patient dies as NHS Trust fails to comply with the MCA
Assessing capacity: lady and man in wheelchair wearing coats looking into the distance

Common errors in Mental Capacity Assessments

I’ve been involved with the field of Mental Capacity for many years now, both as an assessor and an advocate. In this time, I’ve encountered a whole range of common errors and mistakes that come up time and time again.

These errors can have a major impact on a person’s quality of life, and ability to make decisions for themselves. Not only that, but they also leave open the risk that if the Mental Capacity decision is ever to be challenged, then it will quickly be dismissed and overruled by governing bodies such as the Court of Protection.

However, thankfully, most of these errors are easily avoidable and simple to resolve with adequate reflection, preparation and the correct training. 

Read More »Common errors in Mental Capacity Assessments