An overview of the Mental Capacity (Amendment) Bill, and the amendments made during the Bills Lords stages, ahead of its Second Reading in the Commons on 18 December 2018. The aim of the Bill is to reform the process for authorising arrangements which enable people who lack capacity to consent to be deprived of their liberty (for the purpose of providing them with care or treatment). This briefing summarises some of the main concerns raised by Peers about the Bill during its passage through the Lords. These include: the definition of deprivation of liberty; the role of care home managers in carrying out assessments, with particular concerns raised about potential conflict of interests in care homes and independent hospitals; the appointment and role of Independent Mental Capacity Advocates (IMCAs); and provisions relating to reviews by Approved Mental Capacity Professionals (AMCPs) and referral to the Court of Protection.

Interim statement providing an update on issues that emerged from the Law Commission’s consultation on the Deprivation of Liberty Safeguards (DoLS), which set out a replacement scheme called ‘protective care’. The paper sets out the background to the review of DoLS. It then outlines the ‘protective care’ scheme described in the consultation paper, which consists of three aspects: the supportive care scheme, the restrictive care and treatment scheme, and the hospitals and palliative care scheme. It then summarises the main messages from the consultation, which received 583 written responses and involved the Law Commission attending 83 events across England and Wales. The results of the consultation found a case for replacing the DoLS. Most consultees found the DoLS to be overly legalistic and found it had failed to deliver improved outcomes for people who lack capacity and their carers. Most consultees welcomed the new provision proposals, but concerns were raised about the financial implications. During the next phase of the review, the Law Commission will produce draft legislation and a final report. The document invites views on the new name for the scheme.

The guide provides practical assistance to anyone who supports an individual to make decisions about their finances. It covers the legislation that governs financial decision-making and makes practical suggestions about how to: empower and support an individual with making decisions about their finances; assess an individual’s capacity in relation to financial decision-making in a way which is decision-specific; apply the Mental Capacity Act to an individual’s situation; and enable decision making by individuals wherever possible.

Advocacy helps to ensure that individuals are in control of their own lives and are supported to make their own decisions. This good practice guide has been developed to help professionals and advocates to decide on the most appropriate route to take to challenge decisions about an individual’s care. It will help advocates to develop a ‘tool-kit’ of different approaches to get the best possible outcome for people depending on their views and the situation. The guide discusses when it is most appropriate to use informal approaches to challenge decisions; the skills required to be effective when taking this approach, including negotiating and influencing; and using Best Interests meetings. It also looks at using formal routes to challenge decisions through the Mental Capacity Act 2005, Mental Health Act 1983, the Care Act 2014, and through formal complaints processes and judicial review. The guide provides useful case examples and makes reference to relevant sections within Acts and Statutory Guidance to illustrate key points. The guide is relevant for professionals across the health and social care sectors, as well as for friends and family members who are supporting a friend or relative.

This Guidance aims to demystify the Court of Protection generally and the role of litigation friend specifically so as to enable more people to consider taking up the role – thereby ensuring the better promotion and protection of the rights of those said to be lacking capacity to take their own decisions.

A brief review of the Compassion in Dying advance decisions form (plus accompanying guidance notes) and the Alzheimer’s Society form.

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.

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.

Up to 75% of UK care home residents may lack the mental capacity to make certain decisions (Wade, Clinical Rehabilitation, 2019, 33, 1561-1570). Care home staff need evidence-based tools to help them assess residents’ mental capacity and provide decision-making support (NICE, Decision-making and mental capacity NICE guideline NG108, 2018). The Mental Capacity Assessment Support Toolkit (MCAST) was designed to support multidisciplinary healthcare staff to prepare, complete and document legally compliant mental capacity assessments. MCAST has not yet been trialled in care homes. This study used a descriptive qualitative design to: (a) understand the current challenges faced by care home staff when supporting residents to make decisions and participate in mental capacity assessments; (b) explore staff members’ support needs in this context and (c) to identify if and how the toolkit could be adapted for use in care homes. A purposive sample of 29 staff working as managers (n = 18), nurses (n = 7) and care assistants (n = 4) across five care homes in North West England participated in five semi-structured focus groups between May and July 2019. Data from the focus group transcripts were analysed thematically (Braun & Clarke, Qualitative Research in Psychology, 2006, 3, 77-101). Five main themes were identified: (a) involvement of residents in decision-making; (b) approaches to mental capacity assessment; (c) working with residents with communication difficulties; (d) feelings about practice and (e) responses to MCAST. Participants appeared competent and confident about supporting decision-making and assessing capacity, but recognised the complexity of this area of practice, and identified a need for further support. They reported a range of challenges, including accessing support from speech and language therapists for residents with communication needs. They responded positively to the toolkit and were keen to use it in practice. This study suggests that care home staff would benefit from, and welcome, support to develop their practice. Furthermore, MCAST appears usable in this context and formal feasibility testing is justified.

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.

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.

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.