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Common errors in Mental Capacity Assessments

Assessing capacity: lady and man in wheelchair wearing coats looking into the distance

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. 

Assessments must be decision-specific

This is perhaps the most common error in Mental Capacity Assessments. In most cases, there is no specific decision identified for the assessment; rather tick boxes have been inserted or the decision is an umbrella of multiple decisions across different areas.  

Remember: assessments must be decision-specific. A separate assessment should be carried out for each decision.  

Understanding the individual’s conditions

Often, in poor quality assessments, the assessor will simply list the individual’s health conditions without any direct link or rationale for how the conditions impact the individual’s cognitive abilities surrounding decision-making. 

This stage asks whether the individual has any impairment or disturbance of the mind that would affect their decision-making ability. If so, describe how it presents for that individual – don’t simply list the condition, or make claims about conditions without documented evidence.

Quality of observations

Again, all too often, poor quality assessments will lack insight, or will include generic observations such as ‘no understanding’.  

Unfortunately, such observations are not at all helpful, and are certainly not decision-specific. In each case, no matter what the decision being assessed, all observations should be relevant, and should include appropriate examples to show exactly how the observations suggest a lack of understanding.

Assumptions made based on prior experience

Sadly, in a number of places I have worked I have witnessed people saying “well I know X cannot or will not engage, therefore I will just write up the assessment”.

As a Mental Capacity Assessor, you should never assume anything about the person being assessed. If the individual does not engage, then it is your role to take the time to see how you can facilitate engagement, and document how you do this.

Adapting to the individual’s needs

In poor quality assessments, there is often no, or very little attempt made to support the individual to make a decision through grading and adaptation. This contravenes the core principles of the Mental Capacity Act (2005). 

Remember: it is your job to adapt your assessment to meet the needs of the individual.

This could be as simple as finding the best time of day to assess, or even just making sure they have their glasses and hearing aids in. In other cases it may need a bit more work to meet the individual’s needs. For example, it may be that you need to provide visual prompts and cues to support, or completing the assessment across several sessions.

Best Interest decisions and care plans

If an individual has been found to lack capacity for a specific decision, then evidence of a Best Interest decision should be provided along with the assessment. However, the story does not stop once the assessment is over. If an individual is found to have capacity in a certain area, then this also needs to be documented and included in their care plan.

Regular review

This is one of the biggest errors I encounter regularly in my work. Quite simply: Mental Capacity Assessments are not reviewed or updated regularly enough.

Through good practice, we should review ALL Mental Capacity Assessments regularly, including DNARs. From my own experience, I would recommend yearly reviews for any assessments related to an individual’s core care plans. Assessments should also be reviewed at any point where an individual changes in their presentation – whether this be an improvement or a decline in their impairment or disturbance of the brain.

Blanket decisions applied to all individuals in a home

In my time as an OT and mental capacity advocate, I have encountered several cases where blanket Best Interest decisions are made on behalf of all individuals in a particular care home. This is clearly not the correct course of action, and again, goes against the principles of the Mental Capacity Act.

Remember: All Best Interest decisions should be person-centred and the least restrictive option.

For example, if an individual has mild-moderate dementia and cannot make major financial decisions due to lack of capacity in this area, this does not then mean that they cannot make decisions around what personal items they buy.

To provide the best level of care, we should always consider how we can support an individual’s inclusion in the decision-making process – even when they lack capacity in a certain area. Our first thought should be how we can support wellbeing and quality of life. Using the example of the dementia sufferer, it may be that they can be shown images to help them decide on personal items; they could also potentially go to the shop with support. It may also be that they can be supported with budgeting and safe money management.

Training and support

Most of the errors described in this blog are easily avoidable and simple to resolve with adequate reflection, preparation and the correct training. If you’d like to find out more about training in this area, or would like support in carrying our Mental Capacity Assessments in your context, please do get in touch.

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