Mental Capacity Act - Patient Information

Why we want you to know about the Mental Capacity Act 2005
It may be that you need to make a decision about your future care and/or treatment due to changes in your health. It may be that you are a relative or carer for someone who needs support to make specific decisions about what happens to them in the future. 

The Mental Capacity Act 2005
The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people over the age of 16 years who live in England and Wales and are unable to make all or some decisions for themselves. The MCA helps to protect vulnerable people who lack mental capacity and to ensure that decisions are made in their best interests.

The Code of Practice provides guidance to professionals and paid carers who have a legal duty to adhere to the Code and to unpaid carers.  

Making Decisions
Many people are able to make every decision about their own lives. A number of people cannot make some specific decisions for themselves. Some people are unable to make any decisions for themselves.

Examples of when people cannot make decisions, could be regarding; - what to eat or what to wear, agreeing to treatment, where they should live or managing their own finances.

Being unable to make a specific decision is referred to as - ‘lacking mental capacity’ or more often referred to as - ‘lacking capacity.’

To make a decision people need to;-
Understand – what the decision is, that needs to be made
Retain – the information about the decision
Weigh up – the pros and cons of what the decision might mean
Communicate back – that they have been able to make the decision – even if they are unable to do this verbally, a way must be found to help them communicate their decision if they have the mental capacity to do so.

A person may ‘lack capacity’ due to a stroke, dementia or a learning disability but there can be many other reasons why a person lacks capacity and it may be that they have capacity at some times but not at others. Having a diagnosis does not automatically mean that a person lacks capacity.
The starting point is always to assume that a person does have mental capacity.

If it is indicated at first, that they do not have capacity, then they may need some practical ways to help them understand. This could include a different approach to how the information is provided or could be that additional information is needed ie. a leaflet, photograph, symbol etc.

Safeguarding - Sometimes people do make unwise decisions and everyone has the right to do so. If people repeatedly make unwise decisions that put them at risk of harm or exploitation or where a person makes an unwise decision that is obviously irrational or out of character it may be that they lack mental capacity in relation to the risks they are taking and a mental capacity assessment may be required.

Assessing mental capacity
If there is concern that you or someone you care for does not have ‘capacity’ to make a specific decision, regarding their care and treatment whilst under the care of Worcestershire Health and Care Trust, an assessment will be required. This will be carried out by a professional involved in your care and treatment or the care and treatment of the person you care for.  This will be recorded on a form and on patient records.

Best Interest Decisions
If people are found to ‘lack capacity’ it may be that others will need to make a ‘best interest’ decision for them. When a decision is made for someone it must be the least restrictive option.
Any decision made on behalf of a person who lacks capacity must consider their past and present wishes, their values, religion and culture and the possibility of them regaining mental capacity.
It may be that an Independent Mental Capacity Advocate  (IMCA) will be required to help with the decision making if there are no family or friends who it is appropriate to consult with during the decision making process. 

Advance Decisions
If a person has made an advance decision at a time when they had capacity and it applies to the specific decision to be made, this must be taken into account when making ‘best interest’ decisions.