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Mental Capacity in Practice

The Mental Capacity Act in practice.

Insight and understanding: Elderly woman smiling as she looks into the distance

What is ‘understanding’?

At its most basic level, ‘understanding’ refers to ‘comprehension’ or ‘insight’ – the ability to apply knowledge to a specific topic or situation. However, in terms of the criteria for Mental Capacity Assessments, these definitions are perhaps a little broad. This is because when we test for capacity, we are not looking for an in-depth understanding of a specific topic, but rather an ability to ‘grasp’ the concept within the context of the individual’s own situation.

Supporting capacity: woman being pushed in wheelchair, looking at the sun

Five key principles of the Mental Capacity Act

The Mental Capacity Act (2005) is built around five key principles. To ensure best practice, it is useful to attach a copy of the five principles to any Mental Capacity Assessment, to be reviewed prior to the assessment in order to ensure the assessment is only completed if necessary and that appropriate support is put in place, while also respecting the individual and their Rights

Supporting capacity with augmentative communication aids

Supporting capacity with augmentative communication aids

There are many different forms of communication, both verbal and non-verbal in nature. While many of us will take communication for granted, others need a little more support. Thankfully there are a range of relatively low-tech aids available to support those with complex communication needs. These include Makaton, PECS and Talking Mats – all of which are put to good use across education and healthcare settings to promote inclusion and person-centred care.

Communication is key: elderly couple sitting in the garden enjoying the sunshine

Communication to support capacity

Communication is an absolutely vital part of the Mental Capacity Act (2005). If we are to support capacity effectively then we should do everything in our power to ensure good, effective communication that is adapted to the needs of the service user. This may mean taking extra measures to aid the process of communication, to consider environmental and/or external factors, and also to make allowances for any fluctuations in an individual’s ability to understand.

Gillick competence. Teenager receiving injection from doctor.

Gillick Competence and the Fraser Guidelines

The Mental Capacity Act (2005) currently applies to adults aged 16 years and above. However, as with many things, there are specific areas of exception. One of which is known as ‘Gillick Competency’ (or Gillick Competence), and the related Fraser Guidelines. These two important judgements set out rules around when a young person is deemed competent to make their own decisions without specific parental consent.

Holding hands

What is a Relevant Person’s Representative (RPR)?

A Relevant Person’s Representative (RPR) is a necessary and essential role under the Deprivation of Liberty Safeguards (DoLS). It is the role of the RPR to maintain regular contact with the relevant person who has been deprived of liberty, and represent them in all relevant matters. This can include: appealing against a DoLS authorisation, requesting a review, ensuring least restrictive practices are in place or raising a complaint.

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.