MCA resources on Decision making

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Assessment of older adults' decision-making capacity in relation to independent living: a scoping review

Health and Social Care in the Community

With a growing global ageing population, approaches to assess and support decision-making are becoming more pertinent. This scoping review aimed to identify and map current knowledge on assessment of older adults' decision-making capacity in relation to independent living. A five-stage scoping review framework was followed. Inclusion criteria were papers on assessment approaches used to evaluate decision-making capacity of older adults, aged 60 years and over for independent living, including studies involving people with cognitive impairment and dementia. Five databases were searched for publications with eligibility criteria from January 2000 to December 2020; 4,118 results were retrieved from sources, resulting in 29 publications being analysed, eight of which were research reports. Publication characteristics and methodologies varied; however, many common components of decision-making capacity assessment for independent living were identified including cognitive, functional, environmental and risk assessment. Overall, a multidisciplinary approach was recommended, and consideration of the person's values and preferences is noted in many publications. Decision-making capacity assessment for independent living of older adults requires multicomponent, multidisciplinary assessment. Future work is needed to examine this from the perspective of older adults and their caregivers.

Last updated on hub: 17 August 2021

Guidance note: relevant information for different categories of decisions

39 Essex Chambers

This guidance note sits alongside our guidance note on carrying out and recording capacity assessments, and is designed to assist social workers and those working in frontline clinical settings when they asked to consider a person’s capacity to make a decision or decisions. As set out in our guidance note, the courts have now applied the MCA 2005 in respect of very many types of decision. In the course of doing so, they have given indications as to what they consider to be relevant (and sometimes irrelevant) information for purposes of those decisions – i.e. what the person must be able to understand, retain, use and weigh to able to make the decision. This guidance note pulls together the guidance given in relation to some of the most common decisions that are encountered in practice in the context of health and welfare matters.

Last updated on hub: 01 June 2021

Scared, angry, discriminatory, out of my control: DNAR decision-making in 2020

The British Institute of Human Rights

Findings from a study to gather information from people who have experienced Do Not Attempt Resuscitation (DNAR) decision making, both since and prior to the Coronavirus pandemic. The report shows a worrying picture around the rights of involvement in care and treatment decisions, including DNARs. The evidence depicts serious issues of discrimination related to disability and age, and the intersection between the two, as well as other factors. Coronavirus has shone a spotlight on this, and some reported an increase in worrying DNAR decisions; but none of this is new, these problems are ongoing. The report’s key findings are: 100% of people involved said there needs to be more easily accessible information about human rights; almost 60% of people involved said they had received no information about their right to life during Coronavirus; 65% of people involved said that they (or a person they care for/about) had a DNAR order put on your medical file. 21% said they didn’t know; of those who had seen a DNAR order put in place almost half (47%) were not related to end-of-life care; less than a third of people (29%) who were involved in DNAR decision-making felt fully listened to, most felt listened to a bit (46%), and 25% felt not listened to; 91% of people involved felt that discrimination was an issue in the DNAR decisions they’d experienced.

Last updated on hub: 03 March 2021

Frustrated, angry and unfair: staff experiences of DNAR decision-making in 2020

The British Institute of Human Rights

This report provides findings and recommendations from research with staff working across health, care and social work, who have shared their experiences of Do Not Attempt Resuscitation (DNAR) decisions. The findings show a worrying picture around the people’s rights to involvement in care and treatment decisions, including DNARs, and in staff confidence and ability to ensure human rights considerations are part of everyday decision-making. Of the people who attended the research workshop and completed a survey: 97% said there needs to be more easily accessible information about human rights; whilst 78% felt supported to meet the legal duty to uphold human rights in their day-to-day work, only 46% said they felt supported to uphold human rights in their day-to-day work during Covid-19; only 8% said people’s right to involvement in care and treatment decisions is explicitly discussed with them, an only 25% felt supported to involve people in DNAR decisions; over 40% of participants said it is assumed that people who have had a DNAR order placed on their file do not have mental capacity (only 26% said capacity assessments (a legal requirement) had been conducted); almost 30% of participants felt DNAR decisions during Covid-19 are worse (14% said they had not changed but were usually poor). 20% had made more challenges to DNAR decisions during Covid-19; only 16% felt fully listened to; more than 50% of participants felt that discrimination at least sometimes happening in DNAR decisions. The recommendations set out in this report focus on both the current Covid-19 context and the wider use of DNAR orders in “ordinary” times, and the need for them to be framed exactly as they are, as human rights issues.

Last updated on hub: 03 March 2021

Understanding clinical decision-making at the interface of the Mental Health Act (1983) and the Mental Capacity Act (2005)

King's Fund

This report explores the context in which the decision of whether to use the MHA or the MCA to authorise a deprivation of liberty is made and the different factors that practitioners use to assess and weigh up which Act is most appropriate and ‘least restrictive’ for the individual concerned. The research used a mixed-methods approach with an online survey to capture the diversity of factors that influence decision-making across clinical groups, and qualitative interviews with clinicians and professionals to explore in depth their understanding of the interface and experiences of making this decision in practice. A large proportion of participants in this research report encountering people to whom this decision applies at least once a month, if not weekly. This decision most commonly applies to people who have dementia, but also to people with a wide range of mental disorders, including those with functional mental illnesses, neurodevelopment and neurological conditions. Participants report most commonly applying this decision to people in community settings, but application also occurs in mental health and acute hospitals including in the emergency department. There is a lack of common understanding around fundamental issues on which this decision is based including core concepts of capacity and objection. Blanket rules exist within professional groups and across different settings that restrict decision-making. The rights afforded to people admitted and treated in some settings and areas of England may not be afforded to those in others. The majority of participants report that their training covered decision-making at the interface of the Acts. However, codes of practice and case law are described as difficult to understand and keep up to date with. Understanding clinical decision-making at the in. Practitioners highlight a number of different ways in which patients are unlawfully deprived of their liberty as a result of the factors outlined above.

Last updated on hub: 23 February 2021

Your rights when detained under the Mental Health Act in England: forensic sections

Equality and Human Rights Commission

This introductory guide is for people detained under section 35, 36, 37, 37/41, 38, 45A, 47, 47/49, 48 or 48/49 of the Mental Health Act. These are people who are suspected or have been convicted of a crime and the courts and doctors have decided that they need to stay in a mental health hospital to get support and care for their mental health condition. The guide explains what rights individuals have and what should happen to them at different stages through their journey in hospital. There are six parts to this guide. The first four parts (A-D) relate to the different stages of stay in hospital in time order, covering: the decision to detain; being detained in hospital; staying in hospital; and leaving hospital. Part E explains how to make a complaint at any stage of one’s stay in hospital; and Part F explains some of the key terms used in this document.

Last updated on hub: 05 January 2021

Introductory guide: your rights when detained under the Mental Health Act in England: forensic sections

Equality and Human Rights Commission

This introductory guide is for people detained under section 35, 36, 37, 37/41, 38, 45A, 47, 47/49, 48 or 48/49 of the Mental Health Act. These are people who are suspected or have been convicted of a crime and the courts and doctors have decided that they need to stay in a mental health hospital to get support and care for their mental health condition. The guide explains what their rights are and what should happen to them at different stages through their journey in hospital. Sections cover: which section of the Mental Health Act can I be detained under; how should the decision to detain me be made; your right to speak to an independent mental health advocate; what can you or your nearest relative do if you think that you shouldn’t be in hospital; and additional guidance for people who need to stay in hospital and how disabled people can get extra help.

Last updated on hub: 05 January 2021

Your rights when detained under the Mental Health Act in England: civil sections

Equality and Human Rights Commission

This guide is for people detained under section 2 and 3 of the Mental Health Act or if you are staying in hospital as a voluntary patient. A voluntary patient (also called an informal patient) is someone who is in hospital but is not detained under the Mental Health Act. They can leave hospital at any time. However, if health professionals are concerned about their safety or the safety of others, they can stop them from leaving for up to 72 hours. The guide explains what rights individuals have and what should happen to them at different stages through their journey in hospital. There are six parts to this guide. The first four parts (A-D) relate to the different stages of stay in hospital in time order, covering: the decision to detain; being detained in hospital; staying in hospital; and leaving hospital. Part E explains how to make a complaint at any stage of one’s stay in hospital; and Part F explains some of the key terms used in this document.

Last updated on hub: 05 January 2021

Introductory guide: your rights when detained under the Mental Health Act in England: civil sections

Equality and Human Rights Commission

This introductory guide is for people detained under sections 2 and 3 of the Mental Health Act, or people who are in hospital as a voluntary patient. A voluntary patient (also called an informal patient) is someone who is in hospital but is not detained under the Mental Health Act. Sections cover: why am I being detained; how should the decision to detain me be made; your right to speak to an independent mental health advocate; what can you or your nearest relative do if you think that you shouldn’t be in hospital; and additional guidance for those who need to stay in hospital and extra help for disabled people.

Last updated on hub: 05 January 2021

RCGP Mental Capacity Act (MCA) toolkit for adults in England and Wales 2011

Royal College of General Practitioners

This tool kit is designed provide information and support for the application of the Mental Capacity Act to GPs and primary care staff.

Last updated on hub: 20 September 2020

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