The Mental Capacity Act in practice.
If someone is unable to demonstrate mental capacity to assign a Lasting Power of Attorney (LPA), and is unable to manage either their health and welfare or property and financial affairs, then an application can be made to the Court of Protection (COP) to assign a deputy to said role if appropriate.
In simple terms a deprivation can be described as a restriction, while a deprivation of liberty is a restriction on everyday living. The Mental Capacity Act enacts vital safeguards and protections an individual who can not consent to their care and treatment is is deprived of said liberties. It protects the individual through upholding their rights, monitoring any form of restriction in place and striving to ensure these are proportionate, justifiable and the least restrictive option. In today’s blog, we consider what these restrictions may include, and the importance of keeping the individual’s voice at the heart of any Best Interest decision.
There are many occasions where an individual may be unwilling or unable to engage with a mental capacity assessment. It is not a rare event by any means, and there are many possible reasons why this may occur. For example, there may be an issue with the specific context of the situation, the individual’s health conditions, the professional’s approach to the test, or even the adaptations that have been made to support.
There are often many complex interactions between legislation and case law – especially in the field of mental capacity and the Mental Capacity Act (2005) specifically. For this reason it is vital for professionals working in this area to ensure they are familiar with updates in case law to ensure those within the system are protected and best practice is upheld.
There are a great many forms that can be found on the UK government website regarding Court of Protection applications, assessments and statements.
A Relevant Person’s Representative (RPR) is an advocate assigned to a person who is under the Deprivation of Liberty Safeguards (DoLS). They are assigned by the Supervisory Authority to ensure the individual’s voice is upheld and supported while deprivations are in place. This includes the responsibility to raise a review and then a challenge if the relevant person is objecting to their care, treatment and/or placement.
When we refer to the ‘threshold of capacity’, we refer to the point at which a professional assessor can claim with confidence that an individual has or has not demonstrated capacity to make a specific decision at a specific point in time. This is determined by what is known as the balance of probabilities.
Mental Capacity Assessments are typically provided by experienced healthcare professionals working independently, or as part of a larger organisation. Unless there is a statutory requirement for the assessment, relating to a specific care or treatment decision, then it is unlikely that an assessment will fall under NHS provision and be free of charge.
In previous blogs we have considered what questions to ask as part of Mental Capacity Assessments. We have also worked through a case study in a two-part blog. In today’s blog, we aim to build upon this knowledge, taking a brief look at the types of questions that can be asked, taking special consideration of just how we frame a question and grade it to the client’s needs.
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.