The Mental Capacity Act 2005

No decisions about me without me

Defining Capacity

‘…a person lacks capacity in relation to a matter if at the material time he is

unable to make a decision for himself in relation to the matter because of an impairment of, or disturbance in the

functioning of, the mind or brain.’

1. A person must be assumed to have Capacity unless it is proved otherwise

2. A person is not to be treated as unable to make a decision unless all practical steps to help them do so have been taken without success

3. An unwise decision does not in itself indicate a lack of capacity

4. An act or decision made on behalf of a person who lacks capacity must be made in their best interests

5. When a person lacks capacity any act or decision should aim to be the least restrictive option

The 5 Principles of the MCA

A Person must be able to:• Understand the information • Retain the information• Use or weigh the information• Communicate the decision

Failure on any one part indicates a lack of capacity to make the specific decision at that particular time

Reasonable belief is sufficient

Anyone can assess capacity

Level 1: Day to day decisionsActivities of daily living, observations and simple diagnostic

tests

Level 2: More complex decisionsInvasive procedures, complex diagnostic tests, treatments, self

discharge

Level 3: Significant decisionsSerious medical treatment, long term accommodation changes

Levels of Assessment

A decision made on the behalf of someone should always be in their

BEST INTERESTS

Best Interest Decisions

Consider if capacity may be regained in the future

Consider the patients past and present wishes, beliefs and values

Consult people who have an interest in the welfare of the patient

Encourage and permit the person to participate

Consider less restrictive options

Do not base the decision solely on age, appearance or behaviour

Do not be motivated by a desire to bring about the persons death

Independent Mental Capacity Advocates - IMCA IMCAs referrals must be made when:

A person has been assessed as lacking capacity to make a decision about serious medical treatment or a long-term

accommodation move and they have no family or friends to consult with

Referrals can be made by telephone on 0845 2799019 or referral forms are available on the RCHT intranet or the SEAP

website: www.seap.org.uk/imca

Deprivation of Liberty Safeguards (DOLS)Must be sanctioned by legal processes

Situation and individual specific

Degree vs IntensityRestraint   Possible Deprivation of Liberty

Doors locked but able to go out Doors Doors locked but unable to go out

Regular escorted leave Leave No leave or very limited leave

Some control exercised Control Extensive control re: care and movement

Compromise re: discharge Discharge Carers discharge request refused

Periodic restraint Restraint Restrained regularly for prolonged periods

Visitors attend during visiting hours Visitors Contact with visitors is severely limited

Some choice and control re: lifestyle Lifestyle Limited control over lifestyle

    *The above is not an exhaustive list

What is a Learning Disability?

A significantly reduced ability to understand new or complex information and to learn new skills (impaired intelligence), with a reduced ability to cope independently (impaired social functioning), which started before adulthood and has had a lasting effect on a person’s development”

Valuing People DoH (200)

Health Inequalities and People with Learning Disabilities in the UK 2012 Eric Emerson and Susannah Baines (IHAL).

Barriers to Health Care for People with Learning Disabilities

Poor and restricted access to mainstream servicesPoor uptake of health screeningDiagnostic overshadowingInadequate diagnosis and treatmentAlien world! unfamiliarDon’t understand what is happeningDifficulty with waiting for long periods of timeDifficulties with being around lots of peopleDifficulties with noiseFrightened of procedures Bad past experiences

What is Autism Spectrum Disorder?

Autism is a developmental disorder which affects the brain and can make communicating and interacting with other people difficult. It is life long and affects how the person makes sense of the world around them.

People with autism can often have problems in 3 areasSocial CommunicationSocial interactionSocial imagination(adapted from The National Autistic society - http://www.autism.org.uk/autism)

Barriers to health Care for people with Autism Spectrum Disorder.

There is high premature morbidity rate and mental health problems amongst this group. Also in everyday health care, they can recover slower from ill health or injury.

Hypersensitivity to noise and light – hospital can be unsettling.Difficulty in booking appointments and keeping them.During medical consultations they can have difficulty discussing

symptoms and expressing views.A combination of the above can lead adults with autism to avoid GP

and not access healthcare or only attend when they reach crisis point.

Reasonable Adjustments

Reasonable adjustments, adapting regular processes to accommodate the disability.

Adjustments may be unique to that person. Equality Act (2010)

Easy read leaflets, DVD’s.Longer appointment times.Access to Liaison Nurse Service.Non clinical environment visits.Projects to actively engage people with learning disabilities and or

Autism.Listening to carers/including them.