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.
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.
Numerous legal cases and rulings have built on the Human Rights Act (1998), Mental Health Act (1983) and Mental Capacity Act (2005). In this blog,…
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.
There is surprisingly little information available on precisely how to complete a Mental Capacity Assessment. Having attended many courses on Mental Capacity in my time, it still surprises me just how many courses fail to set out what to ask, how much to record, what information is relevant and what to do next.