Transcript Slide 1

Mental Capacity Act 2005:
a practice-based course
Supporting older people in care homes
and the community as they would like.
Session One
Introduction to the Mental Capacity Act 2005
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Overview of the course
Objectives
To enable delegates to gain:
• An increased understanding of the provisions of the
Mental Capacity Act 2005
• Knowledge of their duties and responsibilities under
the Mental Capacity Act 2005
• Skills to clearly document the rationale, the process
and the outcome of decision-making, when the person
lacks capacity to make a decision.
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Copyright
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SHARP Records and Plans
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Three Stories: The Mental Capacity Act
A DVD
“Three Stories” is a powerful documentary depicting three
real life stories. It shows how the MCA empowers and
protects people who may lack the mental capacity to make
some decisions for themselves.
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Before the Mental Capacity Act
2005
• No formal processes to follow
• No provision for a legal representative
• A diagnosis could mean a person is labelled ‘incapable’
• No legal framework for ‘living wills’
• Lack of clarity caused inconsistency for people needing
support and those caring for them
• What about ‘next of kin’?
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Who is affected by the Mental
Capacity Act 2005?
• There are over 2 million people who may be
affected at any one time
– since they may lack the mental capacity to make a decision about their life
or welfare
• There are over 6 million paid and unpaid
carers who are supporting these people.
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What is mental capacity?
It means:
• A person is said to lack mental capacity if:
– they fail to make a particular decision
– or they fail to take a particular action for themselves at the time the decision or
action needs to be taken.
• Mental capacity can be time specific
• Mental capacity can be decision specific
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What is not covered by the Act
• Consenting to marriage or civil partnership
• Consenting to have sexual relations
• Consenting to a decree of divorce/dissolution of civil partnership
• Consenting to child being placed for adoption or the making of an
adoption order
• Discharging parental responsibility for a child
• Giving consent under the Human fertilisation and embryology Act
1990
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5 key principles
1.
A person must be assumed to have capacity unless it is established that they
lack capacity.
2.
A person is not to be treated as unable to make a decision unless all practicable
steps to help him to do so have been taken without success.
3.
A person is not to be treated as unable to make a decision merely because he
makes an unwise decision.
4.
An act done, or decision made, under this Act for or on behalf of a person must
be done, or made, in their best interests.
5.
Before the act is done, or the decision is made, regard must be had to whether
the purpose for which it is needed can be as effectively achieved in a way which
is less restrictive of the person’s rights and freedom of action.
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Assessing capacity
Assessing capacity is:
• Decision specific, time specific
–
Because capacity can be decision and/or time specific
• Has a 2 stage test:
1. Does the person have an impairment of the mind or brain?
2. If so, does that impairment mean the person is unable to make the decision at
the time it needs to be made?
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“Inability” to make a decision
A person is unable to make a decision if they cannot:
1. understand relevant information about the decision to be
made
2.
retain that information in their mind
3.
use or weigh that information as part of the decisionmaking process, or
4.
communicate their decision by any means.
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Best interests
1. the person’s past and present wishes and feelings and
any written statements, made when he had capacity
2. the beliefs and values that would be likely to influence
his decision
3. other factors he would be likely to consider if he were
able to do so.
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The decision maker must:
• involve the person who lacks capacity
• have regard for past and present wishes, feelings,
values, beliefs and especially any written statements
• consult with and take into account others who are
involved in the care of the person, especially any legally
appointed person, eg a Lasting Power of Attorney (LPA)
or Independent Mental Capacity Advocate (IMCA)
• not make assumptions based solely on the person’s
age, appearance, condition or behaviour
• demonstrate and document the process of decisionmaking
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New roles, functions and guidance
• The Mental Capacity Act 2005 Code of Practice
• The Deprivation of Liberty Safeguards - Code of Practice
• Court of Protection
• Office of the Public Guardian
• Independent Mental Capacity Advocates (IMCA)
• Lasting Power of Attorney
• New criminal offence
• Advance care planning
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Code of Practice
• The Act sets out a broad framework - the Code
explains how the Act is to be followed
• The Code has legal force and the following
must have regard to it:
– Those with formal powers (attorneys/deputies)
– Those acting in a professional capacity or who are being paid, such as health
and social care staff
– Those carrying out research under the Act
– Independent Mental Capacity Act Advocates (IMCA)
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What decisions need a formal process
and what can be defined as ‘ongoing
care’ and recorded in the care plan?
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Decision: Choosing a balanced diet
Plan of support:
• Offer Mrs Smith a choice of dish at each mealtime, by
showing her two dishes. Explain clearly what each dish is.
• Give her time to make a choice. Mrs Smith shows her
choice by nodding.
• If Mrs Smith is unable to make a choice, make a choice for
her, taking into account her likes & dislikes and to provide a
varied and nutritious meal.
• Keep a record of food and fluid intake to demonstrate a
balanced and varied diet over a period of time.
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Decision: Visiting the local garden
centre with other residents
Plan of support:
• Offer Mrs Smith the opportunity to go on trips with other residents,
according to her interests.
• Explain what she is likely to see and do on the trip, using pictures
from brochures and photographs, if available.
• Observe Mrs Smith’s facial expression, which can give an indication
of her wishes.
• If Mrs Smith is unable to show her decision then make the decision
about the trip, taking into account her known preferences and
likelihood of Mrs Smith enjoying the trip or not.
• Keep a record of your decision.
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Decision:- Choosing clothing,
suitable for the temperature and
situation
Plan of support:
• Offer Mrs Smith a choice of two items of clothing and give
information about any relevant activities in the day and the
weather.
• Give her a choice of the jewellery and accessories.
• Give her time to make a choice. Mrs Smith sometimes shows her
choice by pointing.
• If Mrs Smith is unable to make a choice, make a choice for her,
taking into account her likes & dislikes and the climate and
occasion
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Once again - Five Core Principles
1. Assume capacity
2. Take all do-able steps to enable a person to
decide
3. An unwise decision does not mean incapacity
4. Always act in a person’s ‘best interests’
5. Use as little restraint as possible.
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Summary
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Questions?
Feedback?
Next session
Thank you for coming!
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