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Mental Capacity in Practice

The Mental Capacity Act in practice.

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.

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Gillick competence. Teenager receiving injection from doctor.

Gillick Competence and the Fraser Guidelines

The Mental Capacity Act (2005) currently applies to adults aged 18 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.

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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.

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lady and man in wheelchair looking out

Common errors found 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. 

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Man with learning disability getting married

Example Mental Capacity Assessments

When I have sought to learn more about the Mental Capacity Act (2005), I have found a unexpected lack of information on precisely how to complete an assessment. Having attended many courses on Mental Capacity in my time, it still surprises me just how many courses fail to even set out what to ask, how much to record, what information is relevant and what to do next.

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Elderly couple sat together looking out to sea

Least restrictive practice: What does the Mental Capacity Act say?

If someone were to say “we can’t go out there at the moment, shall we have a cuppa we wait” or  “sorry, it’s dark outside so garden’s not open until to 8am”, be provided with a medication to sedate or calm as a medical restraint such as promethazine or lorazepam, be secluded to a certain area to keep their dignity if undressed or be restrained in their best interest once all other alternatives have been trialled repeatedly, these are all forms of restrictive practices and restraint. No matter how cooperative or accepting of the support provided. They are different forms, different levels, but all restrictive, affecting a person’s freedom of movement and choice through limiting access, provision of sedative medication, seclusion or restraint.

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Lady in wheelchair facing away from camera, looking down a paved street

How to explain assessments to people who are being assessed

We all have a large amount of underlying assumptions or associations in all elements of our lives, which we are encouraged as working professionals to stop and reflect on in order to reduce the impact of these on our daily practices. Without this professional conduct we risk being biased, unprofessional, incur misunderstandings or cause offence. Whether it is surrounding age, gender, health conditions, political outlook, faith, religion, education or appearance.

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

Mental Capacity Assessments: Where to start?

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. 

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