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.
This is just the same with terminology; we will instantly have a personal schema around different words and their meaning based upon our experiences, values and understanding, whether it is the words Doctors, Dentist or Disability.
Reflecting on our own understanding
Take a moment to reflect back to what your first thoughts of Mental Capacity were, has this changed over time? In what way? What are other people’s impression or knowledge of Mental Capacity. We need to be aware of our own presumptions, assumptions and values, but also that of our teams and those we work with.
People’s awareness and insight as to what mental capacity is, naturally varies dependant upon their experiences. However more often than not, from assessments I have completed in the past, I have heard that it is to; “to check I am sane”, “make sure I am not doo-lally”, “count how many marbles I have left”, “sign me off as senile” or similar responses. Which demonstrates how people associate the terminology of “Mental capacity” quite negatively still. Influences of this are vast, from the historic image of asylums and institutions, negative images in the media, portrayals in the film industry and the social circles we inhabit.
This makes it vital to support a positive, true understanding of what a mental capacity is when explaining the purpose of speaking and assessing that day. Over time, you will develop key phrases, examples as well as resources to support a smoother transition and flow. I found it best to start simple, ask what they understand first so you can clarify their thoughts or understanding before moving onto explain, if required. This will help put the individual at ease, through listening to their voice, reassure that you are not here to trick or trip them up and help establish a trust for sharing their thoughts and feelings.
Explaining Mental Capacity
Remember to explain it in their terminology and put all our fancy phrases and technical jargon aside, while ensuring we are not being condescending. A good way to help this, may be to link to informed consent:
“Mental Capacity Assessments protect your rights and decisions, by checking we have your informed consent for X. So this will explore what your understanding is around this area, your recollection of this information, your reasoning and your decision for X. I am not here to judge if it is a good or bad decision, but to ensure you have all the relevant information available to weigh up the pro’s and con’s. So if you are unsure of anything, please do ask and we can take a further look. Do you have any questions?”
This may need further grading to simplify, depending upon who you are working with. Further, depending on the decision you are looking at, it might not be directly related to informed consent, but related to a decision not to do something or an advance directive, Will or placement. So one size won’t fit all for explaining, take time to pre think through the best phrasing to help understanding. Another example of an introduction may be:
“I understand you have been looking at Y, so this Mental Capacity Assessment is aimed at unpicking this decision further to protect your decision, upholding your rights, your voice and safeguard your decision. I am not here to trick or judge you. We will looking at the understanding around Y, what you can recall around Y and your reasoning for your decision. Do you have any questions?”
There are also a growing range of easy read documents available online that may support depending on the decision being addressed, or you may find it useful to form your own for where you are working.
Lastly, be sensitive, recognise that there may be a lot of questions around that area, which might be of a personal nature for them. Encourage them to ask if they would like to know why you are asking that specific question or explain why it is relevant. Reassuring that if it is too much or they would like to take a break at all that this is okay, just to let you know.