The Mental Capacity Act (2005) is built around five key principles. To ensure best practice, it is useful to attach a copy of the five principles to any Mental Capacity Assessment, to be reviewed prior to the assessment in order to ensure the assessment is only completed if necessary and that appropriate support is put in place, while also respecting the individual and their Rights
Least Restrictive Option
It has been a trying few years for everyone with the impact of Covid and related restrictions. During this time, I have been privileged to see some incredible person-centred care. For example, one of the homes I have worked with went above and beyond to ensure that an isolating gentleman with learning disabilities, who had tested positive, had a staff member at his door throughout the day to engage with him and give him someone to talk to. They also supported him by doing activities at a distance and he had thrice-daily supported access to the gardens to get fresh air and a change of scene.
We often hear the words least restrictive practice, which we often associate with physical or medical restraint. However, an often overlooked area of least restrictive practice is placement, which is more easily thought of as where someone lives and the restrictions placed upon them.
If someone were to say “we can’t go out there at the moment, shall we have a cuppa we wait” or “sorry, it’s dark outside so garden’s not open until to 8am”, be provided with a medication to sedate or calm as a medical restraint such as promethazine or lorazepam, be secluded to a certain area to keep their dignity if undressed or be restrained in their best interest once all other alternatives have been trialled repeatedly, these are all forms of restrictive practices and restraint. No matter how cooperative or accepting of the support provided. They are different forms, different levels, but all restrictive, affecting a person’s freedom of movement and choice through limiting access, provision of sedative medication, seclusion or restraint.