The concept we call mental capacity

Featured article - 21 October 2016
By Stef Lunn, Independent Social Worker with a special interest in service user engagement and mental capacity

The Last week I found myself formally assessing the capacity of lots of different people facing a range of challenges:

• Assessing the capacity of a person with Parkinson’s disease to remain living in a difficult and sometimes abusive relationship
• Checking the views and understanding of a person who lives in a cluttered and risky environment and is struggling with mobility
• Seeing whether a person with suspected dementia, who chooses not to see professionals, understands the consequences of that choice
• Identifying whether the person who turns away non-white carers is making a conscious, unacceptable decision, or whether the consequences of this action need to be mitigated because of their limited insight.

• The National Mental Capacity Forum

These scenarios and many others like them have capacity at their heart. Undertaking these assessments give me a great opportunity to talk with people about the concept we call ’mental capacity’ as set out in the Mental Capacity Act. I often find myself paraphrasing the act very crudely with an explanation like ‘If he knows what he’s doing then it’s his choice, and if he doesn’t, then we might need to make some of the decisions for him’ Whether the person is assessed as having capacity to make their own choice, or not, they often still have a right to be supported with the problems they’re facing. This is where the listening, thinking, negotiation and planning really come in. Working with the person themselves, family, friends and other professionals, we need to think up the best approach to tackling the problem. Something that will work for the person facing the problem. It’s seldom easy to find the answer and we will all have different ideas about what is acceptable, and this is where we really need to set some parameters to work within.

It is the Mental Capacity Act which gives us these parameters, neatly packaged into 5 principles, underpinned by natural justice and common sense. This carefully crafted piece of law is written in a way that allows everyone to understand the basis of people’s rights and responsibilities. It’s not a special piece of knowledge just for psychiatrists, social workers or other specialists. It offers helpful guiding principles for the whole team, professionals and non-professionals alike. There’s no telling which member of the team will suggest the solution which fits best, and having a shared understanding of the rules enables everyone to contribute. I, for one, am grateful to have such a helpful piece of law to work with, and will keep taking the everyday opportunities to spread the word. I encourage other people to do the same whenever they are able, to find the best outcomes for the people we support.