In previous blogs we have considered what questions to ask as part of Mental Capacity Assessments. We have also worked through a case study in a two-part blog. In today’s blog, we aim to build upon this knowledge, taking a brief look at the types of questions that can be asked, taking special consideration of just how we frame a question and grade it to the client’s needs.
Open-ended questions tend to be framed around one of three key words: ‘how’, ‘what’ or ‘why’. These types of questions allow for a wide range of answers. They also help foster an open dialogue where the individual responding can share as much or little as they feel necessary, able and comfortable to provide.
These tend to be the best kind of question to ask as part of a Mental Capacity Assessment (or ‘Test’) if the client is able to answer them. This is because they allow for free recall and also help demonstrate the individual’s natural understanding of a topic, while also highlighting areas that need further clarification.
Unlike open questions, closed questions tend to lead to short, limited responses without elaboration, and tend to be based around questions that include words such as ‘where’, ‘when’, ‘which’, ‘who’ or ‘did’.
Of course, a client may choose to expand upon these questions of their own free choosing, however, the question(s) in themselves are not designed to prompt a longer response.
Within a Mental Capacity Assessment, closed questions may be used to help focus an individual’s responses, grade the assessment to support participation or to establish a clear answer if a previous response has been vague.
Whether questions are open-ended or closed, Mental Capacity Assessors need to be sure they are not asking ‘loaded’ or ‘leading’ questions that may prompt the responder to answer in a certain way – where the answer is implied in the question itself.
Examples of leading questions:
- Do you remember visiting the new home yesterday? [client responds ‘yes’]
- Did you like your visit to x? [client responds ‘yes’]
- Would you like to go there again? [client responds ‘yes’]
- Would you like to live there? [client responds ‘yes’]
- Did you feel bad when you had no money left after shopping? [client responds ‘yes’]
- Why is it bad to spend all your money? [client responds: ‘no more shopping’]
- Shall we budget your money so you can have some money each day? [client responds ‘yes’]
Each of these examples guides and directs the responder to answer in a certain way, with a clearly implied outcome hidden within the question itself. While each of these questions may be well intended, they do not fairly assess the responder’s decision-making ability; nor do they support the responder to make a decision for themselves.
Framing questions to support capacity
In the following two examples I have adjusted the previous questions to improve phrasing and remove the implied outcome. Each of these examples can be supported with communication aids (either low or high-tech) if required, in order to aid participation.
Remember: the individuals should always be given time to process the question(s) and consider their response. Assessors should repeat questions as needed, and be prepared to give examples in order to explain. This may include using a scale, or explaining each option relating to the question, for example, ‘was it a bad visit?’, ‘was it an okay visit?’ or ‘was it a good visit?’
Whatever the nature of the question, it is important that you give a range of positive and negative options to ensure a fair and balanced response.
Example 1 – a visit:
- Where did you go yesterday?
- What did you think about your visit?
- What did you like about the visit? What did you not like about the visit?
These questions can then be followed-up with further open and closed-ended questions to enable client’s participation as part of a person-centred approach.
Example 2 – personal finances:
- How much money do you get each day/week?
- What do you spend your money on?
- Do you use your money quickly or slowly?
- How do you feel when you finish using your money?
- Why is that?
- Are there other things you would like to do in the week?
- How much do they cost?
With this scenario I would have two weeks’ activity timetables available, with pretend money to spend on each activity to help the client visualise their spending. We would then consider the options. This may then lead to further questions such as: ‘Would you like to spend your money on one day each week or across several days?’, while referring back to the different options we had discussed in the previous step.
Assessment training and support
If you have more questions about applying Mental Capacity Assessments in everyday practice, please do get in touch. We have a range of training options available for teams, including both in-person and online options. We also offer bespoke consultancy services, and can carry out Mental Capacity Assessments for complex cases.