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Two-Stage Test

Loneliness and isolation: Elderly woman with head resting on her arms looking out of window.

Mental Capacity and Insight

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.

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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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Close up of an elderly woman sat in a cafe

Mental capacity two stage test: Is a formal diagnosis required?

In previous blogs, we have explored some of the many different elements required to assess mental capacity for a specific decision. This brings us then to the two stage test, which is composed of the functional and diagnostic steps that are then bound together as part of the causative nexus (the justifiable link).

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Man sat on a picnic bench, smoking while playing a guitar

Case study: How to document a Mental Capacity Assessment

The way professionals document mental capacity tests can vary greatly across the health and care sectors. In some cases, professionals are not yet using the updated assessment format of Functional and then Diagnostic. More worrying still is that in some cases it’s not just the documentation format that varies, but the quality of the content that is recorded.

In this blog, we examine two example assessments, using the case of Dylan to show the impact documentation can have on the outcomes of an assessment.

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