Mental Capacity Act

Purpose of training session

To gain a basic understanding of the Mental Capacity Act and how it applies to your role including: • The 5 Principles of the act • Assessing capacity and who decides • Best interest decisions • Documenting decisions • Independent Mental Capacity Advocates • Lasting Powers of Attorney • Advance decisions • Court of Protection • The Public Guardian • Criminal offences • Where to get more information

Human Rights Act Influences • Article 2 • Article 3

- Right to life - Prohibition of inhuman or degrading treatment

• Article 5 - Right to liberty • Article 8

and - Right to respect for private and family life such as autonomy self-determination

16 Impairment or disturbance that affects the way that the mind or brain works

What’s in a name?

Ability to Make a Particular Decision at the Time it Needs to be Made Act!

Mental Capacity Act

Summary – When does the act apply?

Is the person 16 or over?

Are they in England or Wales?

Do they have an impairment?

Is the impairment severe enough that it could effect their capacity to make a particular decision at the time it needs to be made?

Does their behaviour, previous capacity issues similar to this decision or information available from others suggest that an assessment needs to be made?

The 5 Core Principles of the act

1.A person is assumed to have capacity.

A lack of capacity has to be clearly determined Capacity cannot be determined by age, disability or appearance alone

2.

The 5 Core Principles of the act

No-one should be treated as unable to make a decision unless all practicable (realistic) steps to help them have been exhausted and shown not to work.

3.

4.

A person can make an unwise decision. This does not necessarily mean they lack capacity.

If it is determined that a person lacks capacity then any decision taken on their behalf must be in their best interests.

5. Any decision taken on behalf of a person who lacks capacity must take into account their rights and freedom of action. Any decision should show that the least restrictive option or intervention is achieved.

How did you decide?

‘ Look’ at/hear the information Understand the information Remember the information Think about it and weigh it up Communicate the decision

HURBE •H ead •U nderstand •R emember •B alance •E xpress

Assessment should lead to..

A reasonable belief that someone has or lacks capacity to make the necessary decision at the time that it needs to be made

Who is the assessor and who makes the final decision?

It could be you

Complex decisions, consulting others You may need to consult others to help you to make a decision about capacity (but the final decision remains with you)

What decision should you make for someone who lacks capacity?

A decision made on the behalf of someone else should always be in their BEST INTERESTS

Best Interests Exercise

Favourite colour Holiday destination Place to retire to Favourite meal Resuscitation or not?

Making sure decisions are in the person’s best interests Things you may need to consider • Equality and Diversity • Adult protection • Human rights • Who you would consult with • How you would involve the service user as much as possible

Best Interests

• Ensure that you do not make assumptions about someone’s best interests • Consider all the relevant circumstances relating to the decision • Consider whether the person is likely to regain capacity. If so can the decision or act wait until then?

• Ensure that you have done whatever is possible to permit and encourage the person to take part, or to improve their ability to take part, in making the decision.

• Decisions concerning the provision or withdrawal of life sustaining treatment the must not be motivated by a desire to bring about the person’s death. • Consider the person’s past and present wishes and feelings (in particular if they have been written down) • Consider any beliefs and values (e.g. religious, cultural or moral) that would be likely to influence the decision in question and any other relevant factors.

Documenting assessments and best interest decisions Do you need a specific form to document capacity issues?

Documenting assessments and best interest decisions • Care plans should show that capacity assessments have been made.

• Records should show in which instances the person may lack capacity.

• Day to day decisions may not need to be documented.

• New decisions or more complex issues should be recorded and include

What else does the act say?

Independent Mental Capacity Advocacy (IMCA) Service

In some cases an IMCA must be appointed.

Some people who lack capacity may have no one to support them (other than paid staff) with major, potentially life-changing decisions so the Act creates a service which will represent and support them.

The decision must be regarding major medical treatment or accommodation moves.

Adult Protection Capacity assessment must be made by referrer first.

What else does the act say?

Independent Mental Capacity Advocacy (IMCA) Service

Bev Price – Manager of service [email protected]

01208 74243

What else does the act say?

Lasting Powers of Attorney (LPAs)

Replace the old Enduring Powers of Attorney in October 2007 and allow people to put in writing who should make decisions for them in the following areas:

• Health • Welfare • Property • Money

Important safeguards

A new Court of Protection

Will have the power to make declarations about:

• Whether someone lacks capacity, • Make orders or appoint deputies to act and

make decisions on behalf of someone who lacks capacity. On many occasions, there may be other ways of dealing with difficult situations without having to go to Court, such as via existing complaints procedures.

Public Guardian

www.guardianship.gov.uk

Tel: 0845 330 2900

What else does the act say?

An advance decision

• Is prepared when a person has

capacity

• It is a decision to refuse

specific treatment and is binding (must be written and witnessed if life-sustaining treatment is being refused)

Advance Decision Website

www.adrtnhs.co.uk

Important safeguards

A new criminal offence

• ill- treatment or • wilful neglect of a person

who lacks capacity

• can lead to fines and

imprisonment

Copies of the Code of Practice can be downloaded from www.guardianship.gsi.gov.uk

Hard copies of this publication are available from TSO Tel 0845 3302900

For more information

Paul Wilkins

Mental Capacity Act Implementation Lead and Trainer Department of Adult Social Care Learning, Training and Development Room 500 Old County Hall Truro Cornwall TR1 3AY Tel: 01872 322289 email: [email protected]

Useful Information

• 6 Booklets – Making decisions, a guide for………….

023 80 878038 [email protected]

• DoH Training sets: Mental Capacity Act 2005 Order Core set and the one that relates to your work area 08701 555455 [email protected]