When it comes to Mental Capacity Assessments, ‘retention’ refers to an individual’s ability to recollect relevant information relating to a specific decision. However, in assessing for retention, it is also important to take into account the second principle of the Mental Capacity Act, which states that we should actively support capacity wherever possible. Therefore, as assessors, we should provide sufficient support to enable retention where possible – be it through labelled items, social stories, easy read guides or so on.
Documenting relevant details
As with other elements of the Mental Capacity Assessment, all questions should relate directly to the specific decision being assessed, and all recorded elements should also only relate to the specific decision.
Therefore, in terms of retention specifically, this means that the assessment should not refer to the individual’s memory overall, but rather to their ability to retain details relating only to that particular decision.
This is one of the most common errors to appear in Mental Capacity Assessments, and something we encounter on an almost weekly basis. Compare the examples below that consider the decision for staff to support with post based management within the home…
Example 1: a poor assessment
“Brenda has poor short term memory, being unable to remember to take her medication, to meet personal needs or recollect where she is.”
Example 2: a basic assessment
“Brenda was unable to demonstrate she could recall relevant information surrounding the management of post at the home.”
Example 3: a good assessment
“Brenda was initially able to show appropriate memories of receiving post in the past. However, Brenda was unable to retain information of letters she may get – such as medical appointments, cards from family etc. On discussing this subject, Brenda became distracted, requiring support to refocus. Brenda could not recall the topic being discussed.
“On discussing post at the home, I told Brenda that our reception team would bring up any letters to Brenda directly, showing an easy read pictures of the front door, post and our reception team. Brenda was unable to recognise the entrance or team members, becoming confused and pushing the images away and asking where her husband was to go home. I reassured Brenda, then re-explained. However, Brenda was unable to follow the line of conversation.
“Therefore, Brenda was unable to demonstrate retention of information surrounding management of post at the home.”
Gold standard assessments
In the first case, there was no reference to the decision in question, while in the second only the decision has been recorded, without any supporting information that actually shows how the decision was reached. However, in the third example, much further explanation is provided, including examples of Brenda’s behaviour and the way she responded to specific questions.
This should be the standard that all Mental Capacity Assessments are held to. With increased documentation of each question and response, alongside support provided to grade and adapt for those high quality assessments.
For help and support with Mental Capacity Assessments, we offer a range of online and in-person training options for you and your team. We can tailor these sessions to your specific needs, and cover all elements of the process including adaptive support, documentation and review. For more details, see our training pages. Or alternatively, contact us.