There are a number of details that need to be established before a mental capacity assessment is carried out. Without this information, the test may not be valid, and the outcome may be challenged at a later date.
In this blog, we examine some of the key points that need to be examined and why this information sharing is important to ensure a thorough, valid assessment.
What information is needed?
Prior to a typical assessment, there are two sets of information the assessor will need. The first is contextual information. This includes the client’s details and summary ‘family tree’ of relevant persons to inform ‘who is who’ during discussions. Contextual information should also include details of what support is currently in place as well as any known health conditions the client may have, including reports and dates of diagnosis if available.
The requesting party should also provide information on the decision to be made. This includes any examples of concerns observed that may have prompted the assessment in the first place, and any information that may inform the particular assessment. For example, if the decision to be assessed is capacity to assign a Lasting Power of Attorney (LPA), a draft of the LPA document would be a minimum requirement before the assessment is carried out.
Why is this information important?
All of this information gives a clear baseline so that if the individual being assessed cannot recall a particular detail, they can be supported properly, in line with the second principle of the Mental Capacity Act.
But more than this, this information can also help to inform the questions that make up the mental capacity assessment, ensuring that all relevant areas are covered.
So, building on the example of assigning an LPA: if a family tree of relevant persons is not provided, directed questions around who is and who isn’t being assigned as an LPA may not be covered. Failure to include these questions reduce the reliability of the assessment, and may even make it invalid.
Another reason why this information is important is that it can help the assessor identify anomalies of cognition. This is especially useful given the limited timeframe of an assessment, especially if the individual is highly articulate, which can sometimes mask underlying conditions, symptoms or concerns.
Case study: Assigning LPA
Continuing the example of an assessment to assign Lasting Power of Attorney (LPA), consider the following case study:
An unnamed professional has entered an assessment regarding the decision to assign a person’s husband to the role of property and finance LPA. The professional has been provided with a basic overview of a few family names, and have been provided a draft LPA document that is awaiting final approval.
The client is reported to have had several transient ischaemic attacks (TIA) across the last year, which has resulted in mild cognitive impairment, that is reported to affect short term memory and word finding. The client’s Mini Mental State Exam (MMSE) is stated to be 22/30.
During the assessment, with graded support, the individual demonstrates a sufficient understanding of the terms, rights, and roles around LPA and voices that they would like their husband and daughter assigned. However, the draft LPA document shows that just the husband is recorded.
In response to the client’s comment, the assessor explores this topic further, with questions around why they want to make this decision and their decision-making rationale. Throughout this process, the client shows clear and careful consideration of the decision to be made, with no apparent inconsistencies, and with only a few minor delays in their ability to find the right words.
The assessor therefore concludes that the client has capacity and recommends an amendment to the LPA document to have her daughter included as a joint LPA.
However, it is only then after the assessment that the requesting party reveals that one of the client’s daughters had sadly passed away two years previously, while the second daughter now lives in Australia and is hard to contact.
Clearly, this additional information has a significant impact on the assessment and its outcome. The assessment is therefore rendered invalid, and the client should be re-assessed.
This example goes to show how difficult it can be for an assessor to identify inconsistencies or processing difficulties without a full view of all the necessary contextual information. Without this crucial context, the assessment would not hold full weight and would not be valid – even with an experienced assessor.