The aims of this research project were to further understand Approved Mental Health Professionals (AMHPs) and Best Interests Assessors’ (BIAs) views and feelings on their professional identity (in terms of their regulated profession) and the effect it has on their practice; and the experiences of people who have received services from AMHPs and BIAs, or those who work with them, and whether their experiences and perceptions differ across the professions; and whether BIAs intend to convert their status to AMCP and ways in which this has been influenced. A multimethod research approach was used, comprising a survey qualified and practising AMHPs; a survey of practising BIAs; focus groups of AMHPs and BIAs; interviews with people with experience of Mental Health Act assessments with AMHPs or ASWs. The study found that both the AMHP and BIA workforces are predominantly made up of social workers and predominantly employed by local authorities. Both professions, to varying degrees, believed that their specialist work was advanced, relational and values-based and for many it went beyond an extension of their primary qualification with enhanced legal literacy that was creative and nuanced. Overall, the majority of AMHPs and BIAs believed that social work had the greatest influence on the work. Generally, aspects of social justice and advocacy, as well as a high level of legal literacy, were clear indicators of the contribution of social work to both AMHP and BIA work. AMHPs and BIAs seem to experience very similar impacts on their health and wellbeing arising out of the challenges they experience. The main difference in this area was that AMHPs report finding their role more challenging than BIAs experience which is likely due to workload pressures and a lack of resources which is beyond their control.

Caring for people at the end of their lives is an important role for many health and social care professionals. One of the key aspects of this role is to discuss with individuals their preferences regarding the type of care they would wish to receive and where they wish to be cared for.  The outcomes of such discussions then need to be documented, regularly reviewed and communicated to other relevant people, subject to the individual’s agreement.  This is called the process of Advance Care Planning (ACP).

This document guides carers of people living with dementia through the process of making difficult decisions during the Covid-19 pandemic whilst taking into consideration wishes and preferences of those they care for and the legal aspects of making decisions. The guide covers a number of decisions carers may need to make if the person they are caring for has or is suspected to have Covid-19. These include decisions such as how to care for them if they are unable to visit them, whether they should go to hospital if they become unwell and what it means to have a do not attempt cardiopulmonary resuscitation order. The guide also provides useful tips for carers such as the Covid-19 symptoms to watch out for which may differ to the commonly recognised symptoms, where to find help and support when making decisions and how to look after yourself as a carer. Topics covered include: thinking about any existing advance care plans; wishes and preferences; legal aspects of decision making; managing care at home; supporting someone in a care home; admitting them to hospital if they are very unwell; support for carers; and how carers can look after themselves during coronavirus and beyond.

Independent advocacy is crucial to make sure a person’s voice is heard and their human rights are protected. This is especially important when a person is subject to compulsory and restrictive powers. Consistent and effective advocacy must be provided to people who most require it, whenever they require it, including to people with learning disabilities, autism or both, who are subject to long term segregation. Improvement to the delivery and commissioning of advocacy is required to achieve this. This briefing highlights the key features of advocacy for people with learning disabilities, autism or both who are in long term segregation, which must be accessible, highly competent, holistic, independent and perceived to be so, connecting, supporting and joined up. The paper also sets out two commissioning options: national commissioning – the model could be specified clearly, activated promptly, its delivery easily monitored, and there would be a clear line of sight on the resources; and local commission – this would allow locally commissioned services to align with most existing statutory provision. Irrespective of the commissioning arrangements, the service must be able to undertake the full range of statutory advocacy duties, rather than referring the person on and requiring that they relate to several advocates. The paper conclude with eight recommendations, including ensuring that advocacy for people in long term segregation is provided on an opt-out basis, to ensure a greater number of people in long term segregation receive the timely advocacy support and representation they need for their voice to be heard and their rights upheld.

This report draws on an examination of the literature and consultation with stakeholders directly involved in advance decisions to refuse treatment (ADRT) to identify ways of increasing awareness and uptake of ADRTs in Wales. The report looks at the current legal position in England and Wales, the current update and effectiveness of advance treatment refusals, attitudes to advance decisions and the views of health and social care practitioners. Barriers to the uptake up of ADRTs identified, include: misunderstanding about what is involved; scepticism about whether the patient’s wishes will be respected; and the mistaken belief that an ADRT is unnecessary if someone has already informed family members or healthcare professionals of what they would want. The report recommends actions for the Welsh Government, charities and other organisations to ensure people understand their options for advance care planning and their right to refuse treatment, if they so wish. These include: an increase in public education; correcting official forms that may mislead people about the legal status of their own or a relative’s expressed wishes; facilitating access to well designed ADRT forms/guidance and skilled support; normalising ADRTs (e.g. offering registration when patients sign up with a GP); training relevant practitioners to ensure that they understand what ADRTs are (and when they are valid and applicable), are able to provide appropriate guidance or referral, and can act in accordance with the law concerning them.

Explains what the Mental Capacity Act 2005 is and why it matters and is intended to help board members of care providers ensure vulnerable service users are not missing out on protections which are their legal right. The paper briefly discusses: capacity and consent; consent on someone else’s behalf; acting where people lack capacity to make their own decisions; best interests; restraint and restriction of liberty; deprivation of liberty; and ill-treatment and neglect. The paper includes a table setting out some questions board members of care providers might want to ask their officers and managers to get assurance that the MCA is being properly applied throughout their organisations.

This guideline covers decision-making in people 16 years and over who may lack capacity now or in the future. It aims to help health and social care practitioners support people to make their own decisions where they have the capacity to do so. It also helps practitioners to keep people who lack capacity at the centre of the decision-making process. It includes recommendations on supporting decision-making, advance care planning, assessing mental capacity to make specific decisions at a particular time, and best interests decision-making. The guideline should be read in conjunction with the Mental Capacity Act 2005. It does not cover Deprivation of Liberty Safeguards processes.

This quality standard covers decision making in people aged 16 and over, who use health and social care services and may lack capacity to make their own decisions (now or in the future). It aims to support implementation of the aims and principles of the Mental Capacity Act 2005 and relevant Codes of Practice but it is not a substitute for these. The standard covers: supported decision making; advance care plans; assessment of capacity; and best interests decision making.

Mental capacity assessment for complex decisions form. Includes guidance on when to use this form and when to use the mental capacity assessment for day to day decisions (less complex decisions).

Mental capacity assessment for day to day decisions (less complex decisions) . Includes guidance on when to use this form and when to use the mental capacity assessment for complex decisions form.

The book provides an overview of the Mental Capacity Act 2005 and the Court of Protection, before turning to a step-by-step guide through the processes of preparing and making an application, funding and representation issues, preparing for and appearing at hearings, evidence, costs, enforcement and appeals. Also, on this site, are links to relevant statutory materials, other guidance, useful (free) web resources, and updates on practice and procedure before the Court of Protection. The updates take the form of blog posts on the site and also (where relevant) updates are cross-referenced to the relevant paragraphs in the book.