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Mental Capacity Act (2005)

Contact meeting between relevant person and their representative

How many stages are there in a Mental Capacity Assessment?

According to the Mental Capacity Act (2005), a Mental Capacity Assessment is made up of two stages, functional and diagnostic. It has therefore been referred to as the ‘two-stage’ test. However, a quick browse online, alongside discussion with different professionals, reveals quite a bit of misunderstanding around how many stages there are and when these stages apply. This is perhaps due to the inconsistent way that assessments are referred to by certain institutions and professional bodies. There also seems to be some confusion between the four steps of the functional stage of an assessment, and the two stages of the overall assessment.

Clearly, terminology is important, and we should make efforts to ensure we are always using the correct terms.

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Man in electric wheelchair looking out to the sea

Case study: What do we mean by ‘decision specific’?

We all make many thousands of micro-decisions on a daily basis, from the way we make a cup of tea to what we watch on TV. However, when it comes to decision making, the Mental Capacity Act (2005) is ‘decision specific’. This means that it relates to a specific decision made at a specific time. It does not refer to decision-making more broadly. This raises the question: how specific do we need to be when we assess capacity?

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Man with learning disability getting married

DoLS in focus: The role of the Best Interest Assessor (BIA)

The primary role of a Best Interest Assessor (BIA) is to complete the Mental Capacity Assessment and Best Interest Assessment steps within the DoLS process. These are recorded as part of Form 3.

They can also be commissioned by the Supervisory Body to complete ‘Age’ and ‘No Refusals’ steps if required.

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Two women interviewing / assessing a person wearing a checked yellow shirt.

The six key assessments for DoLS

The Code of Practice for DoLS (2008) directs that wherever possible, DoLS authorisations should be applied for in advance of a hospital or care home admission, in order to ensure that appropriate safeguards are in place from day one. As such, a DoLS application should really be made at the point where the individual is assessed prior to admittance, in order that the application be processed in time.

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Care in the home: young lady helping older woman with walking sticks

Occupational Therapy and Mental Capacity

In Terry Pratchett’s Going Postal, we meet the main character Moist von Lipwig as he tries to dig his way out of prison using a broken spoon. Just when he thinks he’s about to reach freedom, von Lipwig discovers that it isn’t the end at all, and that someone has hidden a brand-new spoon for him inside the wall in order that he carry on digging. This is because Lord Vetinari likes to provide ‘Occupational Therapy’ to all his inmates!

While Terry Pratchett’s wonderful satire doesn’t paint Occupational Therapy (OT) in a wholly positive light, though very entertaining, it does give some small insight into the sort of ‘purposeful activity’ that can be used to aid recovery, support identity and help people maintain cognitive and physical function.

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