The term ‘insight’ is often used by health and care professionals. For example, it may be recorded that a person ‘lacks insight’ into their toileting personal care needs. By which, the professional may be seeking to state (in a diplomatic way) that the person does not recognise when they have been incontinent.
The term is also used in other contexts in the care setting as well. For example, that a person may ‘lack insight’ into their mobility as a result of their dementia. By which the professional may be indicating that the individual’s falls are due to their impaired short-term memory and orientation, and that they are not able to process that their movements have deteriorated due to their Parkinson’s-related dementia which is causing them to have increased falls.
But is the term ‘insight’ really appropriate to use in all documents and assessments? Is there a need for more direct explanations to ensure clarity? By starting with the concept of insight within the functional aspects of the two-stage test are we being objective within our assessment, or starting from a discriminatory stance?
Important points on this matter can be found in the case of CT v London Borough of Lambeth & Anor (2025, EWCOP 6 T3). Within which, there is emphasis for assessors to keep to the wording, construct and intent of the legal test. The case also highlights the strengths of using a structured assessment to ensure all aspects are adhered to appropriately in line with the law.
This case covers a wide range of important points to apply in assessing Mental Capacity; building upon the findings in the case of Re Sudiksha Thirulamesh (dec’d) (2024, EWCA Civ 896), which we discussed in a previous blog. The implication from these cases seems clear: just as a person’s lack of belief in the information they have regarding the decision should not be used to conclude that a person lacks capacity to make a decision, nor should a person’s perceived ‘insight’ into their circumstances be treated in the same manner.
Add to this the vital matter that mental capacity is time and decision-specific. This means that any changes in presentation or circumstances should prompt a review and reassessment of mental capacity for the decision, alongside the corresponding Best Interest Decision.
There is a very useful commentary by Barrister Alex Keene (2025) that further considers this case in great depth. We would also encourage anyone reading this blog to read the full case judgement, as it has significant direction for those working in the field of mental capacity in practice.