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Preparing questions for a complex Mental Capacity Assessment

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In our last blog, we considered the complex case of ‘P’ – an individual being assessed for mental capacity with respect to their change in accommodation, as well as their wish to take responsibility for managing their inheritance.

The case study highlighted several major issues in the way the original mental capacity assessment had been completed, including concerns around the lack of support to help P communicate autonomously, and the lack of documentation around P’s condition and capacity.

In this follow-up blog, I have separated what was originally one single assessment into two separate assessments to be considered independently of each other. In doing so, I have proposed an initial series of questions for each area. This list is not exhaustive, but is an example baseline of the sorts of questions that should be prepared in advance of a complex case such as this.

Any questions that are raised during the assessment should of course also be added to the list. Similarly, if any responses to questions are unclear, then further questions may be needed in order to clarify responses.

Remember: it is good practice to keep questioning in a person-centred, graded approach, until you are confident of the outcome.

Preparing for the assessment

Preparation is absolutely key when it comes to Mental Capacity Assessments, and is even more important for complex cases such as with the individual I have referred to here as ‘P’.

In this particular case, I have met the individual in question on several occasions and so have graded my questions accordingly.

In some cases, far more adaptation would be needed in order to support participation and capacity. This may require grading questions into smaller steps, and may also require visual aids (or other communication tools) that are personalised to the individual and the area being addressed.

Example questions

Decision 1: relocation to a private care home

  • Where are you staying at the moment?
  • Is that your normal home?
  • Do you know what town that is in?
  • When did you move there?
  • Can you tell me why you are there?
  • Where do you normally live? (Encourage them to give a specific location.)
  • How long have you lived there?
  • Who do you normally live with?
  • Do you get on with [X]?
  • How much support do you have? (This might need grading to each activity of daily living.)
  • What activities do you normally do each week?
  • Do you get on with the staff?
  • Do you know how much it costs per week/month?
  • Who pays for your placement?
  • Have you lived anywhere else in the past?
  • Why did you move?
  • What was your experience of moving home?
  • I understand we are looking at you considering moving from [X] on a permanent basis?
  • Where would you like to move to?
  • Why would you like to move?
  • What is it like there? (Encourage them to describe and discuss.)
  • Who lives there?
  • Have you met any of the new residents? Do you get on?
  • What is a typical week like there?
  • What activities and support do they provide? Can they help you do the things you enjoy?
  • Do you get on with the staff?
  • What is your room like?
  • Do you know how much it costs per week/month?
  • Who will pay for your placement?
  • Do you know where it is (geographically, how far) compared to your normal home?
  • Have you met any of the staff? What do you think of them? (Give their initial impressions.)
  • How much would it cost?
  • Who will pay for this placement?
  • What are the positives about your present home?
  • What are the challenges about your present home?
  • What are the positive about the new home?
  • What are the challenges about your new home?
  • What are the most important things you want where you live?
  • Based on this, where do you want to live?
  • Why have you chosen this option?

Decision 2: withdrawing and managing money from a Trust fund (inheritance)

  • Do you know what a Will is?
  • Do you know whose Will we are going to discuss today?
  • When was this Will read/when did it come into action?
  • Do you know what the Will contains/says?
  • Do you know what a Disabled Trust is?
  • Do you know why they used a Disabled Trust?
  • How much do you get per month/year from your Disabled Trust?
  • How do you access your Disabled Trust money?
  • Do you have any other income?
  • Where does this come from?
  • Do you know why you get these benefits?
  • Where do these benefits go to?
  • How do you access your money?
  • Do you have any help and support with managing your money?
    • I would then break this down further to explore knowledge of value, money, safety, access and management, upholding principle two of the MCA, through use of aids including but not limited to, visual representatives of money, a calculator, cubes, white board, social stories or other resources.
  • What do you spend your money on? (e.g. cost of home, bills, activities, travel, food, personal items, etc.)
  • I understand you would like to withdraw your Disabled Trust. If this happens will your benefits continue?
  • What are the benefits of the Disabled Trust?
  • What are the disadvantages of the Disabled Trust?
  • Do you know how much is left in the Disabled Trust?
  • What are the advantages of withdrawing the remaining money?
  • What are the disadvantages of withdrawing the remaining money?
    • At this stage, I would clearly inform P that if the money is withdrawn, this would increase their savings; when savings are above £xxxxx then benefits stop, including that of the placement being payed for. Before asking if you withdraw your Disability Trust will your savings be more or less than £xxxxx? (I would ensure I uphold principle two of the MCA, supporting with physical visual aids, equipment or other resources to aid application if needed)
  • If you withdraw your Disability Trust what will happen to your income? What will happen to your outgoings?
  • What happens when your money drops below £xxxxx again?
  • What would happen if your money ran out?
  • Based on this, do you want to continue with your Disabled Trust or withdraw it?
  • Why have you chosen this option?

These questions are just the start

Of course, these questions are just a starting point for two separate assessments based on the case of ‘P’, whose original poorly conducted assessment was discussed in our previous blog.

As mental capacity assessors, it is our job to confirm responses with the individual and check their accuracy, doing as much of this as we can prior to assessment. However, further investigation may be required post assessment if new information comes to light. This is vitally important, as those we are working alongside are being assessed due to reasonable doubt surrounding their cognitive processing – suggesting their accuracy and orientation may be impaired.

If you have any questions following these blogs, please do get in touch. As consultants, we offer personalised services to support professionals and organisations to develop aids to support mental capacity assessments for specific decisions, as well as supporting a baseline development of questions that can then be further tailored to the individual and their circumstances.

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