Mental Capacity Act

An individual (aged 16 and over) lacks capacity if they're unable to make a particular decision. An assessment of capacity must be based on a person’s ability to make a specific decision at the time it needs to be made, not their ability to make decisions in general. Someone can lack capacity to make one decision but be able to make others. Everyone must apply the five guiding principles of the Mental Capacity Act:

• An assumption of capacity
• Supporting people to make their own decisions
• People have the right to make eccentric or unwise decisions
• Where someone lacks capacity staff must act in the person's best interests
• Where someone lacks capacity any action we take on their behalf must generally be the least restrictive option

Capacity is assessed for a particular decision by asking three key questions.

1. Can the person make their own decision. This is a functional test and involves assessing whether someone can:

• Understand the information relating to the decision
• Retain the information long enough to make the decision
• Use and weigh the information
• Communicate their decision

2. Does the person have an impairment of the mind or brain, or some sort of disturbance that affects the way their mind or brain works. This could include the following:

• Conditions associated with some types of mental illness
• Dementia
• Significant learning disabilities
• Effects of brain damage
• Physical or medical conditions causing confusion, drowsiness, loss of consciousness
• Delirium
• Concussion, head injury
• Symptoms of alcohol or drug use

3. If the person does have a mental impairment, is this the reason that they cannot make the specific decision.

These three questions demonstrate how an assessment of mental capacity is carried out.

If the person lacks capacity to make their own decision, a serious medical treatment or a permanent change of accommodation is proposed, and the person has no appropriate family or friends to support them with the decision, a referral to an 'independent mental capacity advocate' (IMCA) must be made by the decision maker. Further information can be found on the VoiceAbility | Independent Mental Capacity Advocacy (IMCA) website.

We have a suite of tools to assist our staff with issues of mental capacity:

• MCA and care planning guides 1, 2 and 3 - guides to check that the MCA has been considered at all points in the care planning process
• Other resources are available on the Social Care Institute for Excellence website
• A variety of guidance materials are available for staff on the Local Government Association website
• MCA '5 and 3 card'
• MCA 'hand card'

Joint DoLS Team:

• Email: dols@shropshire.gov.uk
• Phone: 01743 255850