MCA resources

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A study exploring how social work AMHPS experience assessment under mental health law: implications for human rights-oriented social work practice

British Journal of Social Work

There is little empirical research focusing on how social workers experience the law in their everyday professional practice, and still less on how mental health social workers experience assessment for compulsory admission under mental health law. The article is informed by a hermeneutic phenomenological approach, drawing on in-depth interviews and practitioner diaries with social work Approved Mental Health Professionals (AMHPs), providing exploration of how social work AMHPs experience compulsory assessment under mental health law in practice. This is revealed as a socio-relational process, involving a focus on the person in their environment in relation to others, such as family and professionals. Ethical challenges realising human rights social work practice are illuminated. This draws attention to how space for such practice can be eroded by systems conditions. The importance of amplifying the voice of the person assessed is highlighted in the context that their voice is severely diminished during the process of assessment. The article provides insights on the complexity involved in compulsory mental health practice, drawing attention to trust as an important concept. Finally, the article argues that realising human rights-oriented AMHP practice requires social work to challenge systems conditions that erode the ability to do so.

Last updated on hub: 13 June 2022

‘They don’t want them to have capacity’: multi‐agency operationalisation of the Mental Capacity Act 2005 in England with adults who self‐neglect

Health and Social Care in the Community

The number of adults who self-neglect and thus fall under the aegis of local authority adult safeguarding procedures in England has increased substantially since the introduction of the Care Act 2014. The requirement for collaborative working between agencies dealing with these adults in a safeguarding context is explicit in government policy and legislation. Decisions made by the multiplicity of agencies that may work with people who self-neglect are largely guided by the Mental Capacity Act 2005 (MCA). The overall objective of this research was to develop a clearer understanding of how the range of agencies that might typically be involved in the life of a self-neglecting person work together. This article examines how agencies put the MCA into practice in their work with people who self-neglect, and how they understand their own and others’ roles and responsibilities in so doing. This qualitative study took place in two local authorities in England from 2016 to 2017 and informed a wider action research study which was completed in 2019. Non-probability purposive sampling was used to recruit participants from the professional groups who might typically be involved with self-neglect cases. À total of 245 participants from across 17 different professional groups took part in semi-structured interviews, in a group, paired or individual format, decided by their customary working configuration. Data from the interview transcripts was analysed using thematic analysis. Three key themes in relation to how participants understood the MCA and multi-agency working emerged from the analysis of this data set. These were; a lack of understanding of the MCA by participants and other agencies; a reluctance to engage with MCA assessments; and a perception of manipulation of the MCA by other professionals. This study underlines the importance of the informed application of the MCA in working with people who self-neglect, and an urgent need to consider how this could be enhanced if the service user is not to experience intrusive interventions resulting from professional misinterpretation.

Last updated on hub: 13 June 2022

A matter of life or death: a rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care under a new Mental Health Act

Safeguarding Adult Reviews (SARs) can be a valuable source of learning to improve mental health care. In light of the government’s commitment to reform the Mental Health Act 1983, this report summarises the qualitative learning from 77 SARs published across 24 London boroughs covering the period January 2017 to November 2020. The premise of this report is that the reform of the Mental Health Act will also prompt a ‘wake up’ of the entire mental health system in London and the rest of England in which parity of social care with health care becomes the ‘new normal’. The SARs analysed for this report tell the stories of Londoners who experienced mental health problems and came to harm or died as a consequence of their condition despite having been in contact with mental health care services and others. From the rapid analysis of the SARs case clusters emerged, with similarities in the individuals’ stories and outcomes. These clusters show that there might be groups of people who require particular attention when it comes to reforming the Mental Health Act – and with it the mental health social care ‘offer’. The stories of these individuals also raise some concerns around human rights, equality and inclusion with the question: Is enough being done to protect the rights of vulnerable people with mental health problems who receive mental health social care and who may rely on social care to respect these rights? The analysis further suggests that there are two major problem areas across virtually all the cases and clusters – professional knowledge and usage of the Mental Capacity Act 2005 and inter-agency working and communication.

Last updated on hub: 20 April 2022

Monitoring the Mental Health Act in 2020/21

Care Quality Commission

Annual report on the use of the Mental Health Act (MHA), looking at how providers are caring for patients, and whether patients' rights are being protected. The report sets out CQC’s activity and findings from our engagement with people subject to the MHA and review of services registered to assess, treat and care for people detained using the MHA during 2020/21. It is largely based on feedback letters on the 620 remote monitoring letters following reviews of 682 wards carried out during 2020/21. These involved private conversations with 1,895 patients and 1,111 carers. The report highlights three key findings. Firstly, the workforce is under extreme pressure; the pandemic has placed additional stresses on staff, patients and carers; staff are now exhausted, with high levels of anxiety, stress and burnout, and the workforce is experiencing high levels of vacancies. The negative impact of working under this sustained pressure poses a challenge to the safe, effective and caring management of inpatient services and to the delivery of care in a way that maintains people’s human rights. Secondly, community services are key to reducing levels of detention in hospital. Not getting the right help at the right time can lead to symptoms worsening and people needing inpatient care. During the pandemic this has been a particular concern for children and young people. We have seen an increase in the numbers of children and young people being cared for in inappropriate settings while they wait for an inpatient bed. Thirdly, urgent action is needed to address longstanding inequalities in mental health care. We remain concerned that Black or Black British people are more likely to be detained under the MHA, spend longer in hospital and have more subsequent readmissions than White people.

Last updated on hub: 28 February 2022

COVID-19 and the Mental Capacity Act in care homes: perspectives from capacity professionals

Health and Social Care in the Community

This study explores the experiences of professionals who worked with care home residents with impaired mental capacity in England and Wales during the COVID-19 pandemic. It explores (i) how competing risks were balanced and (ii) how the Mental Capacity Act (MCA) functioned in care homes under pandemic conditions, with particular focus on its associated Deprivations of Liberty Safeguards (DoLS) and Independent Mental Capacity Advocacy (IMCA) systems. Between March and May 2021, an online survey and five focus groups aimed at professionals who worked in or with care homes during the pandemic, were held. The study explored issues pertaining to residents with impaired mental capacity, alongside several other topics on which the authors report elsewhere. For this paper, the researchers filtered data to only include responses from ‘capacity professionals’. The resulting sample comprised 120 (out of 266) survey participants and 18 (out of 22) focus group participants. The researchers performed manifest content analysis on the filtered data and found that (1) participants reported a ‘massive discrepancy’ between the ways different care homes balanced the risk of COVID-19 infection with the risks associated with severe restrictions. (2) Some suggested this was due to vague guidance, as well as care home type and size. Participants told us the pandemic (3) obstructed smooth operation of statutory safeguards designed to protect residents’ human rights and (4) resulted in confusion about the remit of the MCA during a public health crisis. The findings raise concerns about the impact of pandemic-related measures upon care home residents with impaired mental capacity. The researchers urge further exploration and analysis of (a) the variability and inconsistency of restrictions applied at care homes, (b) the strain placed on key safeguards associated with the MCA, (c) uncertainty about the remit of the MCA during a public health crisis and (d) the human rights implications hereof.

Last updated on hub: 10 February 2022

Social work expertise, best interests and the court of protection

Journal of Adult Protection

Purpose: The purpose of this paper is to consider the role of social work professional evidence in mental capacity law, specifically Court of Protection proceedings. The authors analyse how social workers perform as evidence givers in this domain and how social work as a profession is perceived alongside other professions within the context of adult social care decision-making in mental capacity law. Design/methodology/approach: This paper draws on textual evidence from judgments and existing empirical data published elsewhere. The authors consider the contribution of social work professional expertise to best interests decision-making in formal legal proceedings which, in turn, reflects on how social work expertise is relevant in everyday practice. Findings: The findings of this paper include that social workers are well placed to be experts on best interests decision-making in mental capacity law. However, the authors show that the Court of Protection has not always endorsed this form of social work expertise in its judgments, meaning that social workers can struggle to articulate an expert knowledge base. Originality/value: Overall, the authors conclude that social work evidence is incredibly valuable as expertise about the person’s best interests, particularly in the domain of welfare cases and care planning.

Last updated on hub: 19 January 2022

Video: Liberty Protection Safeguards - Looking forwards

Social Care Institute for Excellence

Video supporting the social care sector to prepare for and embed Liberty Protection Safeguards (LPS) within practice, aligning with human rights and duties of the Care Act.

Last updated on hub: 27 October 2021

Mental capacity toolkit

Bournemouth University

These materials have been created to help support health and social care professionals working with individuals whose decision-making capacity is limited, fluctuating, absent or compromised. Demographic changes mean there are increasing numbers of people living with conditions which may impact on their decision-making capacity, and as such it is vital that professionals are confident in their understanding use of the Mental Capacity Act 2005. This tool brings together information from a range of professionals working in the field of mental capacity to provide a comprehensive guide to practice. It is part of a wider research project funded by the Burdett Trust for Nursing. Sections include: 1. Reflecting on values and bias in mental capacity decision-making; 2. The history and current context of mental capacity legislation and policy; 3. The concept of mental capacity; 4. Best interests; 5. Supported decision making; 6. Deprivation of liberty: human rights; 7. MCA in clinical decisions for care and treatment; 8. MCA and the Office of the Public Guardian (OPG) role.

Last updated on hub: 26 September 2021

Mental Capacity Act 2005, Deprivation of Liberty Safeguards England, 2020-21

These official statistics provide findings from the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) data collection for the period 1 April 2020 to 31 March 2021. DoLS are a legal framework that exist to ensure that individuals who lack the mental capacity to consent to the arrangements for their care, where such care may amount to a "deprivation of liberty", have the arrangements independently assessed to ensure they are in the best interests of the individual concerned. The data is collected from local authorities in England, who are the supervisory bodies for authorising deprivations of liberty of adults in care homes and hospitals. There were 256,610 applications for DoLS received during 2020-21. This is a small drop of approximately 3% compared to the previous year, following an average growth rate of 14% each year since 2014-15. The proportion of completed applications in 2020-21 that were not granted was 57%. The main reason was given as change in circumstances, at 60% of all not granted cases. The proportion of standard applications completed within the statutory timeframe of 21 days was 24% in 2020-21. The average length of time for all completed applications was 148 days.

Last updated on hub: 01 September 2021

Operationalising the Deprivation of Liberty Safeguards (DoLS) in support of brain injury survivors – views from practice

Journal of Adult Protection

Purpose: Deprivation of Liberty Safeguards (DoLS), as part of the Mental Capacity Act 2005 (DoLS, 2007), was established to provide a legal framework for decision-making in respect of adults who lack capacity to make decisions in relation to their care and residence in England and Wales. The purpose of this study was to explore the DoLS decision-making process from the perspectives of health and social care practitioners when working with individuals with an acquired brain injury (ABI). Design/methodology/approach: A total of 12 health and social care practitioners were interviewed in 2019–2020 about their experiences of using and making or supporting decisions in the DoLS framework with ABI survivors. Data were analysed, and a tentative explanation of variations in DoLS decision-making was developed. Findings: Three distinct approaches emerged capturing different decision-making styles (risk-averse, risk-balancing and risk-simplifying) which appeared to influence the outcome of DoLS assessments. A range of mediating factors seemed to account for the variability in these styles. The wider contextual challenges that impact upon practitioners’ overall experiences and use of DoLS processes in their ABI practice were noted. Research limitations/implications: The findings highlight a need for changes in practice and policy in relation to how DoLS or similar processes are used in decision-making practice with ABI survivors and may be relevant to the implementation of the Liberty Protection Safeguards that are replacing the DoLS system. Originality/value: To the best of the authors’ knowledge, this is the first study to explore accounts of DoLS decision-making practices in ABI service.

Last updated on hub: 18 August 2021

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