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Home » The Mental Capacity Act (2005) » Mental Capacity Assessments » What questions should I ask?

What questions should I ask?

Elderly gentleman and young man in red hat smiling and enjoying time together. Photo by Nathan Anderson on Unsplash.

When it comes to designing questions for a Mental Capacity Assessment, preparation is key. Given the sheer diversity of personal circumstances, outside influences, and decisions being addressed, no assessment can ever be truly standardised.

It is therefore your role as assessor to keep exploring points until you are sure of the outcome, returning to reassess if necessary.

Formulating your questions

To start with, we recommend you design your assessment using the following steps.

  1. What is the decision being considered?
  2. What are the core concepts or topics surrounding the decision?
    • Ensure all concepts are decision relevant.
  3. Next, transfer these concepts into graded questions, taking into account the format these questions are presented in.
    • For example, you should take into account: the sequence questions are asked in; the complexity of information in the question; does an easy-read document or visual aid need to be used; does the individual require any objects of reference to support understanding? etc.
  4. Finally, add questions that use this information to weigh up the decision and show the individual’s rationale.
    • During these questions, you can provide information if they are unsure of what the terms mean or specific details. However, you should make a note of these occasions, taking account of how often they require information repeated as well as level of grading. The key question to consider in terms of retention is can they retain (with support) the information provided for long enough to weigh up the decision?

This begins the process of tailoring each mental capacity assessment to both the decision and the individual.

Remember this list is not exhaustive. While completing this assessment, if any answers are not complete, new information is identified or there remains uncertainties, keep questioning until you are confident of your conclusion.

While looking at communication, clarify what communication method works best for the individual before the assessment takes place, alongside any sensory needs they may have. For example, ensure they have their glasses, hearing aids are working, documents are in a readable size and format, do they use Makaton or talking mats, can they write/type/use augmentative technology, is an interpreter required etc. Make a note of the responses, considering coherence, relevance to question asked, format of response etc. A decision of lack of capacity should not primarily rest on a person’s ability or inability to communicate.

When reflecting upon the individual’s answer to these questions, it is important to return to the question of if the average 10 people on a London bus were in this situation and asked these questions, how much would they know and retain around this topic. This is the threshold for which reasonable capacity is compared and establish, more commonly referred to the Balance of Probabilities.

Worked example

  1. Decision:
    • To continue a ‘normal’ diet or follow the SLT recommended diet.
  2. Core concepts:
    • What constitutes a ‘normal’ diet (including its consistency)?
    • What has been the individual’s change of health?
    • What is their present swallow ability? What is the SLT guidance with regards to choking, aspiration, pureed diet, thickener, flavour etc.?
  3. Graded questions:
    • What type of diet do you normally eat? What do you enjoy about it? Are there any things you do not like about your diet? What texture is that food – can you give examples?
    • Can you tell me of any recent health changes – why you are here? Tell me more about your diagnosis? Has this impacted your meals?
    • Recently, has there been any difficulties when eating your normal diet? What happens when a person chokes? What does aspiration mean? What is the worst case scenario?
    • Who are the SALT team and when did they assess your swallowing? What did they advise?  What does this new diet look like? Have you tried any meals?
  4. Further questions:
    • Can you tell me why the SALT recommended the change of diet?
    • You’ve said that you would like to continue with the normal diet, rather than soft diet, can you share why this is important for you?
    • What other advantages are there to this diet?
    • What are the risks of declining this advice?
    • Have received any other advice from family or friends? How has this impacted your decision?
    • Based upon the risk for choking, staff will need to supervise more closely, do you know why? How does this make you feel?
    • Considering what we have been speaking about, what diet would you like to follow and why?*

[*Please note, your questions can be recorded in any format that suits you. We find word maps a great way to break this down, but for the purpose of this illustrated example, we have used a list.]

Further support

Need help developing questions for your Mental Capacity Assessment? Contact us now to find out how we can support your training needs. We can provide numerous case study examples, and can also tailor advice to your specific context. For particularly difficult cases, we can also carry out assessments on your behalf.