2. Mental Capacity Act 2005
Briefing
House Keeping
Group Agreement
Icebreaker
3. Overview of the Course
What is the Mental Capacity Act?
What is it founded upon? (The Five Key Principles)
What questions determine lack of capacity?(2 Stage Test)
4 stage assessment (questions to ask)
So what if capacity is lacking? (Best Interest Checklist)
DOLs
How it links into advanced decisions, (LPAs) Lasting Power
Attorneys, Court of Protection & Public Guardian
The role of Independent Mental Capacity Advocates (IMCAS)
Useful sources of information
Conclusions
4. Aims
To explore Mental Capacity Act and its Five Key Principles
To enable staff to use the Mental Capacity Act in the workplace
To establish a shared understanding of best working practice in
offering support
To understand the different safeguards introduced by the Act
5. Objectives
Apply the principles of the Mental Capacity Act
Understand why it is needed
Understand that mental capacity is the ability to make a decision
Know what triggers an assessment
Understand how to assess for capacity
Understand what help/ support somebody will require to make a
decision
Know who can be a decision maker
Understand the meaning of ‘Best Interests’
Describe the role of Independent Mental Capacity Advocates
(IMCA’S)
6. What is the MCA?
Provides a framework to protect those who lack capacity to make
decisions for themselves
Puts existing good practice, as recognised in common law, into a
legal framework
Applies to all people over the age of 16
Affects all carers in all settings, wherever they may be
Came into force between April and October 2007
Puts needs and wishes of a person who lacks capacity at the centre
of any decision making process
Code of Practice
7. 5 key principles
A person must be assumed to have capacity unless it is established
that he lacks capacity’
‘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’
‘A person is not to be treated as unable to make a decision merely
because he makes an unwise decision’
‘An act done, or decision made, under this Act for or on behalf of a
person who lacks capacity must be done, or made in his best
interests’
‘The act or decision is to be achieved in a way that is less restrictive
of a person’s rights and freedom of action’
8. 5 key principles (cont)
In plain English this means:
Assume capacity
Enable capacity
An ‘unwise’ decision does not automatically mean lack of capacity
Decisions made for others must be in their Best Interests
Use the least restrictive alternative
9. Why we need the Act –
who it affects
It is an issue that could potentially affect everyone
Up to 2 million people in England and Wales lack mental capacity to
make some decisions for themselves
Up to 6 million family and unpaid carers, and people involved in
health and social care who may provide care or treatment for them
10. Why we need the Act –
who it affects (cont)
Many people with the following:
Dementia
Learning disability
Brain injury
Severe mental illness
Temporary loss of capacity - unconscious, affects of alcohol or
drugs, trauma, severe phobia, delirium
Anybody acting in connection with a person who may lack capacity
Anyone planning for the future
11. What is mental capacity?
Mental capacity is the ability to make a decision
Capacity can vary over time
Capacity can vary depending on the decision to be made
Physical conditions, such as location, can affect a persons capacity
Staff must not assume a lack of capacity because of a person’s age,
physical appearance, condition or an aspect of their behaviour
Refers to an ability to make a decision, or take action, at the time the
decision or action needs to be taken.
‘Mental Capacity’ simply means our ability to be able to make
decisions which are defensible in law.
It is a legal issue not a personal attribute
‘Capacity’ is not general! It is time and decision specific
12. Triggers
Staff should start from a presumption of capacity then take into account
(Principle 1)
The person’s behaviour, their circumstances, any concerns raised by
people.
What could be a trigger?
13. Triggers - how to assess
capacity
Carry out the two stage test of capacity:
Is there an impairment of, or disturbance in, the functioning of the
person’s mind or brain (Diagnostic Element)
If so, is the impairment or disturbance sufficient to cause the person
to be unable to make that particular decision at the relevant time
(Functional Element)
To ‘prove’ stage 2 you must use 4 functional assessments
14. 4 stage assessment
To understand the information relevant to the decision.
To retain the information relevant to the decision being
made long enough to make a decision
To use or weigh the information to make a decision
To communicate the decision (by any means)
15. Support for someone to make a
decision?
Provide all relevant information, • Be aware of any cultural,
don’t give more detail than ethnic or religious factors that
required may have a bearing
Include information on the • Try to choose the best time of
consequences of making, or not day for the person
making, the decision • Try to ensure that the effects
Provide information on options of any medication or
Consult with family and care staff treatment are considered
on the best way to communicate • Take it easy – one decision at
Make the person feel at ease and a time
don’t rush • Be prepared to try more than
once
Remember Principle 2
16. Who can be a decision maker?
Varies depending on the individuals’ circumstances and the type of
care treatment or decision being considered
Health and Social care staff, family and unpaid carers can be
decision makers when decisions relate to carrying out an act on
behalf of somebody who cannot consent
The person delivering the care or treatment makes the decision
about whether to deliver that care treatment
17. Acts in Connection With Care &
Treatment “Personal Care”
Helping with washing, dressing or personal hygiene
Helping with eating and drinking
Helping with communication
Helping with mobility (moving around)
Helping someone take part in education, social or leisure activities
Going into a person’s home to drop off shopping or to see if they are
alright
Doing the shopping or buying necessary goods with the person’s
money
Arranging household services (for example, arranging repairs or
maintenance for gas and electricity supplies)
Providing services that help around the home (such as homecare or
meals on wheels)
Undertaking actions related to community care services (for
example, day care, residential accommodation or nursing care)
18. Acts in Connection With Care &
Treatment “Healthcare”
Carrying out diagnostic examinations and tests (to identify an illness,
condition or other problem)
Providing professional medical, dental and similar treatment
Giving medication
Taking someone to hospital for assessment or treatment
Providing nursing care (whether in hospital or in the community)
Carrying out any other necessary medical procedures (for a blood
sample) or therapies (for example, physiotherapy or chiropody)
Providing care in an emergency
20. Best interests
Any decision or act must be in a person’s best interests. Wh e n
m aking d e cis ions , s taff s h ou ld take into accou nt of th e following:
equal consideration and non-discrimination
considering all relevant circumstances
regaining capacity
21. Best interests (cont)
Permitting and encouraging participation
Special considerations for life-sustaining treatment
The person’s wishes, feelings, beliefs and values
The views of other people
22. Acting lawfully
Section 5 of the MCA provides protection from liability provided that all
the 3 MCA requirements are met (3 R’s)
Reasonable steps are taken to establish whether the person lacks
capacity for the decision
Reasonably believe that the person lacks capacity and provide the
evidence
Really believe that you have acted in the persons best interest
23. What kind of records will staff
need?
Day-to-day – record and review, but elaborate records not
required on every occasion about decision / acts of care
Professional records – record assessments of capacity
Formal reports as required
24. Restraint
Physical restraint is lawful if the 2 conditions are met (MCA section 5 & 6: Code of Practice)
Where a person who lacks capacity resists (restriction of liberty or
movement is restraint)
Includes acts of: Personal care, Healthcare and treatment
5. Reasonably believe that restraint is necessary to prevent harm to
the person who lacks capacity
6. The amount or type of restraint used and the amount of time it lasts
must be a proportionate response to likelihood and seriousness of
harm
Restraint press release
25. Restraint (cont)
Physical restraint is lawful if the 2 conditions are met (MCA section 5 & 6: Code of Practice
For example, a carer may need to hold a person’s arm while they
cross the road, if the person does not understand the dangers of
roads. But it would not be a proportionate response to stop the
person going outdoors at all. It may be appropriate to have a secure
lock on a door that faces a busy road, but it would not be a
proportionate response to lock someone in a bedroom all the time to
prevent them from attempting to cross the road.
MCA Code of Practice 6.47
26. Deprivation of Liberty
Safeguards
Introduced into Mental Capacity Act 2005 thought the Mental Health Act
2007
DOLs are there to prevent arbitrary decisions that deprive vulnerable people
of their liberty
DOLs are there to protect individuals and if they do need to be deprived of
their liberty give them right of appeal, representatives, and for the deprivation
to be reviewed and monitored
DOLs are for the purpose of giving a person care and treatment
27. Deprivation of Liberty Safeguards
The Bournewood Case
This tests the boundary between restraint and human rights under
Article 5 of the European Convention on Human Rights (ECHR) –
the right to liberty for people who do not have capacity
Any deprivation of liberty is lawful only if there are safeguards such
as the Mental Health Act 1983, a court ruling, the Mental Capacity
Act or Deprivation of Liberty Safeguards
28. The Bournewood Case
A man (unnamed) with learning disabilities who could not speak
became upset and started self harming when attending a day centre
He was taken to Bournewood hospital and kept there. His carers
were told they could not visit him
Doctors were worried the man would want to go home with the
carers and that he should be kept in hospital and treated. His carers
disagreed with this and took the case to court
This tests the boundary between restraint and the loss of human
rights under Article 5 of the European Convention on Human Rights
(ECHR) – the right to liberty for people who do not have capacity
29. Deprivation of Liberty
Safeguards
The safeguards apply to people over the age of 18 who have a
mental disorder and lack capacity to consent to the arrangements
made for their care or treatment and are not detained under the
Mental Health Act 1983 or have a court order in place
A deprivation of liberty can only be authorised in a hospital or
registered care home
30. Deprivation of Liberty
Safeguards
Managing Authority – Hospital / Care Home
Supervisory Body – PCT / Local Authority
Authority to deprive a person of their liberty
Assessments – age assessment, no refusal assessment ( in conflict with an
advanced decision / decision of donee or deputy), mental capacity assessment,
mental heath assessment, eligibility assessment and a best interest assessment
Authority granted for a maximum of one year but can be reviewed at
anytime
Examples of DOLs
31. Deprivation of Liberty Safeguards
Hospitals and registered care homes have the responsibility for
managing the Deprivation of Liberty Safeguards
If you think there is a unlawful Deprivation of Liberty happening in a
hospital or registered care home you should initial raise it with the
hospital or care home. If the issues isn’t resolved you then raise it
with the DOL’s Co-ordinator
If you think there is a Deprivation of Liberty happening outside of a
hospital or registered care home it maybe a safeguarding issue
Deprivation of Liberty maybe used as a protective measure /
outcome from safeguarding
DOLs video
32. Lasting and Enduring Powers of
Attorney (LPA / EPA)
Two different LPAs to cover a range of circumstances:
- personal welfare (including healthcare)
- property and affairs (finance)
Who can be an attorney?
An attorney must be over 18 years old
An individual can be an attorney for more than one person
Staff should NOT normally act as attorneys
33. Enduring Powers of Attorney
Established under previous legislation to manage property and
financial affairs
No new Enduring Powers of Attorney after the MCA is implemented
Existing Enduring Powers of Attorney will be valid whether registered
or not
34. What is a Court Appointed
Deputy?
A person appointed to make certain decisions on behalf of a person
who lacks capacity to make those decisions
Could be a family member, carer or any other person that the Court
thinks suitable including a trust
The difference between a Deputy and a LPA:
Deputy is appointed by the Court
LPA is granted by the person
35. Advanced Decisions
An advanced decision is prepared when a person has capacity
It is a decision to refuse specific treatment and is binding
Other expressions of an individuals preferences are not binding but
must be considered
Staff must be able to recognise when an advance decision is valid
An advanced decision must be written, signed and witnessed if life-
sustaining treatment is being refused
36. Advanced Decisions (cont)
A relevant Lasting Power of Attorney will override an advanced
decision if it is made after the decision
An advanced decision can be withdrawn:
By the individual while they have capacity
If the individual does something that is clearly inconsistent with the
advance decision
By the decision maker, if the treatment is now available that was not
available when the advance decision was made
Advanced Decision press release
37. The Court of Protection and
The Public Guardian
The MCA introduces two new bodies:
The Court of Protection
Office of the Public guardian
38. The Role of the Court of
Protection
Decides whether a person has capacity to make a particular decision
for themselves
Make declarations, decisions or orders on financial or welfare
matters affecting people who lack capacity to make such decisions
Appoint Deputies to make decisions for people lacking capacity to
make those decisions
Decide whether an LPA or EPA is valid
Remove Deputies or attorneys who fail to carry out their duties
Hear cases concerning objections to register an LPA or EPA and
make decisions about whether or not an LPA or EPA is valid
39. The Role of the Public Guardian
Keeps a register of Lasting Powers of Attorney and Enduring Powers
of Attorney
Monitors attorneys
Receives reports from attorneys and deputies
Keeps a register of orders appointing deputies
Supervisors deputies appointed by the court
Directs Court of Protection visitors
Provides reports to the court
Deals with enquiries and complaints about the way deputies or
attorneys use their powers
Works closely with other agencies to prevent abuse
40. Independent Mental Capacity
Advocates (IMCA’s)
IMCA’s are a local service to represent the interests of:
People lacking capacity when making a serious decision about
medical treatment or a move, and in some adult protection cases,
and if
They have no one else to speak for them other than paid carers, and
their care is arranged by their local authority or NHS
The IMCA has a right to information about the person who lacks
capacity but is not the decision maker
41. IMCA’s (cont)
Duties of an IMCA
Support the person who lacks capacity, represent their views
/interests
Obtain / evaluate information through interviewing the person and
examining records / documents
Obtain views of professionals / paid workers providing care
Identify alternative courses of action
Obtain a further medical report, if required
Prepare a report (that the decision maker must consider)
42. IMCA’s (cont)
IMCA’s are provided to support people in cases that involve:
A long-term care move
Serious medical treatment
Adult protection procedures
A care review
Deprivation of Liberty
43. New criminal offences of
ill-treatment or wilful neglect
New offences apply to:
People who have the care of a person who lacks capacity
An attorney under a Lasting Power of Attorney
A deputy appointed by the Court
Criminal offences can result in a fine and/or a sentence of
imprisonment of up to five years
45. Conclusion
MCA – Provides a framework to protect those who lack capacity
Why it is needed – It is an issue that could potentially affect
everyone
Mental capacity is the ability to make a decision
What triggers an assessment
How to assess for capacity – 2 stage test
46. Conclusion (cont)
4 Stage assessment
What help / support someone could need to make a decision
Record keeping
Who can be a decision maker?
Meaning of ‘Best Interests’
Acting lawfully in connection with care / treatment
47. Conclusion (cont)
The Bournewood Case & DOL’s
Lasting Power of Attorney / Enduring Power of Attorney
Advanced decisions
Role of the Court of Protection & Public Guardian
Independent Mental Capacity Advocates (IMCA’S)
New Criminal Offences
49. “The great end of learning is not
knowledge, but action”
Peter Honey
Neil Lee
07753283048
neilleetraining@gmail.com
Thank you
Notas do Editor
This session is about looking at how the Act affects you as a member of staff and how we use it, put it into plain English The MCA affects everybody in our lives It is a framework act, so it doesn’t always have the answers
Decision you have made recently ice breaker, tie it back to MCA & Decision making.
We are going to talk about The MCA explain what it is, why we need it and what it means to you and the service users We say the word capacity, What does it mean Why it came about Explain the 5 key principles and when they should be used We will be explaining what questions you should ask to determine if a person has capacity or not What happens if the person lacks capacity – there is a best interest checklist to work with – factors to take into consideration when determining best interests of people and how it links into advanced directives and lasting power of attorney Talking about the role of independent advocates - the decision making pathway for people and some useful sources of information Finishing with a conclusion – questions / answers / concerns around your role within the MCA Evaluation
Gives clear guidance What to do to help someone make a decision How to work out if someone can make their own decision What to do if someone cannot make decisions The MCA applies to everyone who works in health and social care and involved in care, treatment or support of people who lack capacity to make their own decisions / consent to treatment or care that is proposed MCA puts the individual who lacks capacity at the heart of decision making and places strong emphasis on supporting and enabling them to make their own decisions. Protects people who have always had difficulty, no longer able, or temporarily unable to make a decision There is an MCA Code of Practice. The MCA was implemented in 2 phases in 2007 April saw the implementation of (IMCA) Independent MC Advocate and the new criminal offences of ill-treatment
5 most important things people must do and think about when using the act
Plain English
To provide consistency in decision making about the care and treatment of people who lack capacity MCA was designed to protect the rights of individuals and empower vulnerable adults In the past some people with learning, dementia and severe mental illness have not been listened to and their right to make a decision have not been recognised The MCA covers decisions that range from day to day decisions, such as what to eat and what to wear, through to more serious decisions about where to live, having an operation, peoples finances and property Breaking down the numbers (2009) – 840,000 people with dementia 145,000people with severe learning disability 1.2 million people with mild to moderate learning disability (many do not lack capacity 120,000 people with severe brain injury
Ask participants for examples of what could affect a persons ability to make a decision.
Capacity - mental or physical ability for something or to do something. A persons capacity to make a decision can be affected by a range of factors such as a stroke, dementia, learning disability or mental illness. A person with a mental illness do not necessarily lack capacity. However people with a severe mental illness may temporarily lack the capacity to make a decision about their care and treatment e.g. a person experiencing a breakdown may temporarily lack capacity Capacity may vary over time depending according to the type of decision to be made. Physical conditions, such as intimidation or unfamiliar environment may affect capacity as can trauma, loss and health problems. A temporary lack of capacity will include people who are unconscious / barely conscious due to an accident / under the influence of alcohol or drugs Capacity is assessed in relation to a specific decision at a specific time EXERCISE – Different case studies can they make the choice on the Key principles.
Doubt as to a persons capacity can occur because of the above Other important triggers could be the death or move of a person that has been caring for them or a referral to an Adult protection Coordinator CARRY ON WITH 2 STAGE TEST 1 If there is not a disturbance then the they have capacity (if the answer is no the person has Capacity) 2 If the answer is yes then the 4 stage assessment should be used
If a person fails 1 or more stages of this assessment then they do not have the relevant capacity
Read out Jake case study. Split into groups again, each group answer one question but look at the others, feedback to main group. 20 minutes
Social care staff will be decision makers for many day to day situations. They may also act as decision makers for longer-term decisions. Health professional will decision makers relating to nursing care Remember – the person delivering the treatment or nursing care makes the decision about whether to deliver the care even if it has been prescribed by someone else. Protection from liability – Staff will not be protected if they act negligently. E.g. if they have not taken reasonable steps to assess the person capacity.
99% of what care staff do is covered in this section Code of Practice Page 95, Chapter 6, Section 5
The MCA does not define ‘best interest’ but identifies a range of factors that must be considered Must not base decisions on a persons age, appearance or make unjustified assumptions based on the persons condition / illness Condition – how they are at that moment e.g. forgetful at present Circumstances e.g. that are relevant to the decision being made. Identify the most important issues to the person Regaining capacity e.g. can the decision be put off for the time being.
Permitting / encouraging participation – finding the appropriate means of communicating / use other people to help the person participate in the decision making process Life-sustaining treatments – the decision maker must not be motivated by desire to bring about a persons death Wishes, feelings etc – especially any written statements made by the person Views of other people – anyone with an interest in the persons welfare or appointed to act on their behalf
3 requirements – 1 reasonable steps have been taken to assess capacity to consent to the act in question 2 reasonably believe that the person lacks the capacity to consent 3 really believe that act they are carrying out is in the persons’ best interest Read out Sharon case study. Split into groups again, and answer the different questions, feedback to main group.
Day to day - Where a person is judged not to have capacity, the, elaborate record keeping is not needed. The decision about the persons lack of capacity must always be recorded in the their file / care plan. This does not need to be done on a daily basis but the record should note the decision and state that it will be reviewed regularly. Professional records – Where the person has had input from occupational therapist, nurse, social workers, psychologists and doctors then the findings must be recorded in the relevant records Important to maintain records and keep up to date as they may be needed by the following
Personal care etc - help with eating, drinking, travel, paying bills, personal care. Healthcare treatment – administering medication, nursing care, emergency procedures You must consider if you can provide treatment in a less restrictive way e.g. giving a person a shower that they can manage themselves oppose to a bath that they would need to be supervised Restraint – staff must reasonably believe lack of capacity, in their best interests – to protect them from harm or protect others from person lacking capacity. Cannot extend to depriving someone of their liberty Protected against civil, criminal charges that could arise through having interfered with a persons body or property in the course of providing care / treatment Read out paper clipping
Go through the slide
The patient was in hospital and lacked capacity to say whether he would stay in hospital and accept treatment. Was a self referral so was not detained under the Mental health Act 1983. The European Court of Human Rights determined that: The key factor in the case was the Health care professionals treating and managing the applicant exercised complete and effective control over his care and movements The court found The concrete situation was that the applicant was under continuous supervision and control and was not free to leave The distinction between restraint and loss of liberty took this case to court. Any deprivation of liberty can only be lawful if accompanied by safeguards similar to those surrounding detention under the Mental health Act 1983. The out come of this case are the Deprivation of Liberty Safeguards..
A mental Disorder is defined by the DOLs Code of Practice as any disorder or disability of the mind, apart from dependence on alcohol or drugs. This includes all learning disabilities.
The Managing Authority which is the hospital or care home who is delivering care or treatment applies to the Supervisory Body which is the PCT or Local Authority for authority to deprive someone of their liberty. If the Supervisory Body accepts the application it will ask for six assessments to be carried out to determine if they are going to approve the application. Theses are: an age assessment, a no refusal assessment ( in conflict with an advanced decision / decision of donee or deputy), a mental capacity assessment mental heath assessment, an eligibility assessment and a best interest assessment. If anyone of these assessments is not fulfilled authority to deprive someone will not be granted. If all the assessments are fulfilled authority to deprive someone of their liberty will be granted for a maximum of one year. The application will be reviewed on a yearly basis but can be reviewed at any time if someone put in a request or the circumstances change.
Go through the slide
Chapter 7 of Code. LPA – is appointing another person to make decisions on their behalf about financial, welfare or health care matters (attorney) The person making the LPA must have capacity to do this. They can give power for the attorney to make all decisions or they can choose the decisions they can make. A person can have more than 1 LPA for different circumstances A person can choose one or both of the LPAs’ A LPA must be validated by using the correct forms and registering with the Office of Public Guardian before it can be used. It is a formal legal document.
EPA’s were established before the MCA. They allow the appointed person (attorney) to manage property and financial affairs on behalf of the donor. The EPA must be registered with the Office of Public Guardian at the onset of the persons incapacity, in order for their authorisation under the EPA to continue Donors can replace their existing EPA with a LPA if they still have capacity
Chapter 9 Advanced decision is about medical treatment that a person does not want to be given in the future if they cannot make their own decision about treatment and it must be followed, even if it would result in a persons death. Validating - If an advanced decision involves refusing life-sustaining treatment, it has to be put in writing, signed and witnessed but, otherwise advanced decisions can be verbal and do not need to be signed or witnessed if they are written down Protection from liability will not apply if a valid and applicable advanced decision is ignored In the absence of an advanced decision, peoples views and wishes, whether written down or not, should be used to assist in planning appropriate care for the s/u and making decisions in their best interests. Statements of wishes and feelings are important, particularly if they are written down, but are not legally binding in the same way as an advanced decision Can be verbal except in cases of life sustaining treatments Cannot request specific medical treatments Read out paper clipping
An LPA will override an advanced decision if the person has capacity and changes their mind. Different circumstances – the person did not anticipate at the time they made the advanced decision and which would have affected their decision had they been able to anticipate them e.g. new treatment or if they have behaved in a way that raises doubt about or contradicts their advanced decision. There are special rules for people who are detained under the MHA 1983: in some circumstances their refusal of treatment for a mental disorder may be overridden Note: if a s/u who has capacity informally/formally informs you of his/her wishes for future care/treatment then you must speak to the person, clarify things and take action Advanced statements –can be used to express personal preferences but are not legally binding as Advanced decisions Janice case Study
Chapter 8 The Court has the same powers, rights, privileges and authority in relation to mental capacity matters as the High Court. It is a superior court of record and is able to set precedents. Final arbiter, highest court in the land in relation to the Mental capacity Act.
Chapter 14 Administration wing of the Court of Protection, has a lot of useful recourses
Chapter 10 IMCA – someone who speaks up for / represents the interests of people who have no family or friends other than paid workers. They help when important decisions have to be made by the NHS or local authorities. The MCA introduced a duty of the NHS / L/A to involve an IMCA in certain conditions. They are only allowed to act for people whose care or treatment is arranged by L/A or the NHS. Duties of an IMCA Support the person who lacks capacity, represent their views /interests Obtain / evaluate information through interviewing the person and examining records / documents Obtain views of professionals / paid workers providing care Identify alternative courses of action Obtain a further medical report, if required Prepare a report (that the decision maker must consider)
Chapter 14 Allegations of offences may be made to the Office of the Public Guardian .(Works with the Police / Adult Social Services when they think some-one has been abused) re any of the above. The penalty for these criminal offences may be a fine and / or a sentence of imprisonment for up to 5 years. The allegations can also be dealt with under the adult protection procedures
Show books and Code of Practice again
MCA - Came into force between April and October 2007. Puts the needs / wishes of the person who lacks capacity at the centre of any decision making Why needed – It could potentially affect everyone. 2 mill in Eng / Wales lack capacity. 6 mill family / unpaid carers who may provide care Mental capacity – vary over time depending on the decisions, physical conditions – location, Triggers – Looking at behaviour, circumstances, concerns raised others Assess for capacity – 2 stage test – impairment, disturbance of the mind/brain if so: is it sufficient to have a bearing on the decision at that time Help / support – information, detailed, consequences, other options, consultation, don’t rush, look at medication times Records – Daily basis –decisions made, elaborate records not needed daily. Professional – assessments of capacity. Formal – health professionals Decision maker – Varies depending on circumstances, type of care treatment , decision being considered Paid carers – day to day decisions e.g. personal care. Family, friends. Person delivering the treatment Best Interests – Any decision or act must be in the persons best interest. List of considerations e.g. wishes, feelings, non-discrimination – age Acting Lawfully – MCA provides protection from liability provided all MCA requirements are met. Bournewood Case – Court case outcome – keeping people against their will is lawful only if detained under the MHA / court ruling LPA – 2 different LPA – personal welfare & property / affairs remember staff not normally act as attorneys. EPA - Established before the MCA, existing ones are valid Advanced decisions – about medical treatment – could be life threatening Court of Protection and Public Guardian roles IMCAS – Speaks on behalf of, make decisions in relation to NHS / Local authorities Criminal Offences – apply to carers, attorneys deputy be court –fined imprisoned
