Heartbeat: Mental Capacity – making the right decision

March 25, 2020

Working as healthcare professionals presents many different scenarios when it comes to making patient-focused decisions. No two situations are ever the same and, at times these decisions can be challenging and complex to work through.

Recognising that we all have a duty of care to those we look after, this month we shine a spotlight on the Mental Capacity Act (MCA). The MCA is designed to protect people who may lack the mental capacity to make their own decisions about their care and treatment.

Examples of people who may lack capacity include those with:

• Dementia
• A severe learning disability
• A brain injury
• A mental health illness
• A stroke
• Unconsciousness caused by an anaesthetic or sudden accident.

Just because a person has one of these health conditions doesn’t necessarily mean they cannot make a specific decision. If a situation arises whereby you believe a patient lacks capacity to make a personal care decision, you must complete a mental capacity assessment.

The MCA has five principles that need be taken into consideration before, during and after a capacity assessment is completed. The MCA says:

1. Assume a person can make a decision themselves unless it’s proved otherwise
2. Wherever possible, help people to make their own decisions
3. Don’t treat a person as lacking the capacity to make a decision just because they make an unwise decision. Unwise is not the same as unable.
4. If you make a decision for someone who doesn’t have the capacity, it must be in their best interests
5. Treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms.

When assessing mental capacity we must remember these two prompts:

• Is there an impairment of the mind or brain that is affecting decision making e.g. dementia, delirium, learning disabilities or a brain injury?
• The capacity assessment must be time and decision specific i.e. what is the actual decision to be made and can the patient make the decision at this time?

When completing a mental capacity assessment it is essential that we document the conversation and discussion. Our notes need to clearly indicate whether the person can understand the decision, weigh up the pros and cons, recall what has been discussed and communicate their decision. If your assessment is that the patient’s capacity is borderline, you must be able to show that it is more likely than not that they lack capacity.

We caught up with Sabina Price-Hickman, Adult Safeguarding Nurse to discuss how to best apply the principles of the MCA.

Q) What are the implications if we don’t establish if a patient has the mental capacity to decide on their care?

A) We recently had a patient in our care that was detained under the Mental Health Act for medical treatment. Over four days psychiatric and medical medications were declined. If we experience situations similar to this it’s important that we first establish if the patient has the capacity to decide on their care. If after a thorough investigation we decide that they cannot do so, we must make a decision about what care to provide. All decisions must be made in the best interest of the patient in question.

It’s important to stress that we must complete mental capacity assessments and clearly outline how we’ve reached our decision, who was involved and next steps.

Q) Where is information about mental capacity online?

A) On Connect you will find the mental capacity policy as well as key contacts.

Q) Are there any other ways to complete a mental capacity assessment?

A) You can request a doctor to complete an assessment via Unity.