MENTAL HEALTH
Mental capacity assessment: working in practice?
The Mental Capacity Act came into force three years ago in England and Wales. It provided, for the first time, a clear legal framework outlining the principles and processes by which to support people in making their own decisions while also offering safeguards should they lack the capacity to make any particular decision, says Toby Williamson
Toby Williamson T
he MCA is highly relevant in health and social care settings
because it applies not only to people who are unconscious or comatose but also to people who may lack capacity due to dementia, learning disabilities or a mental illness.
It is crucial that doctors and other healthcare professionals who require a patient’s consent before providing treatment and care understand how to assess a person’s capacity to give this consent, in accordance with the MCA and its accompanying code of practice.
However, levels of awareness and understanding of the MCA vary across the country and in different service settings. The Mental Health Foundation, a national research and development charity, has released a report using data collected from the online tool AMCAT (Assessment of Mental Capacity Audit Tool), which appears to reinforce this view and should be the cause of some concern for senior health service managers.
Launched earlier in 2010, AMCAT enables staff working in health and social care settings to audit and evaluate mental capacity assessments they have been involved with. Free, confidential and simple to use, the tool provides an instantaneous, automated report that indicates to the person who has completed it how well the assessment adhered to the Mental Capacity Act and the
38 nhe
code of practice. The tool also has the potential to be used by organisations for the purposes of auditing adherence to the act across all their staff.
The Mental Health Foundation report used aggregated data based upon the entries from over 1500 individuals using AMCAT. It found that the main reason for carrying out an assessment of mental capacity, in relation to the person’s disability was that the person had dementia (38%), a mental illness (27%) or a learning disability (18%).
Although 33% of respondents said that they carried out the assessment because the person was having a problem making a decision, 38% said they carried out the assessment because of the person’s disability, history, diagnosis, illness, age, appearance, or behaviour.
The Act makes it clear that mental capacity should be assessed on a decision-specific basis and not for these other reasons alone. In other words, those 38% of respondents appeared not to be correctly following the law.
Also worrying was that 25% of respondents said that they carried out the assessment because the person was making a decision that the respondent (or someone else) thought was unwise. The third principle of the Act states that one should not assume someone lacks capacity because they are making a decision that appears unwise.
The AMCAT also asked respondents what the decision was for which they were assessing a person’s capacity. The results showed 18% of decisions involved either consent to serious medical treatment (10%) or to another healthcare/medical decision (the other decisions involved social care, accommodation, financial and everyday issues). However, worryingly, 10% said ‘decision-making in general or more than one decision’. This is in contravention of the Act which emphasises that capacity should be assessed on a decision-specific basis.
Another concerning finding arose from respondents’ entries when they were asked whether they thought the person had capacity before carrying out the assessments – 48% said ‘yes’ but 52% did not believe the person had capacity. The first principle of the Act states that one should always assume someone has capacity until it is proven to the contrary.
Obviously, someone who is unconscious or in a coma will not have capacity to make a decision and some people with very severe dementia or very severe learning disabilities for example, may well appear not to have capacity to make a decision. However, the Act aims to ensure that assumptions of incapacity are not automatically made – the fact that the majority of respondents were making this assumption (particularly given that 56% of the people who were being
Cont. page 41 Nov/Dec 10
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