Objective: To investigate how people with communication and understanding difficulties, associated with conditions such as dementia, autism and intellectual disability, are represented in research guidance supplementary to the Mental Capacity Act (MCA: 2005) in England and Wales. Methods: A documentary survey was conducted. The sample comprised the MCA Code of Practice (CoP: 2007) and 14 multi‐authored advisory documents that were publicly available on the Health Research Authority website. Textual review of key words was conducted followed by summative content analysis. Results: Representation of people with communication and understanding difficulties was confined to procedural information and position statements that focused mainly on risk management and protection. Whilst a need to engage potential participants was recognized, guidance provided was imprecise. Conclusions: Tensions exist between the protection versus empowerment of people with communication and understanding difficulties in research. The development of structured, evidence‐based guidance is indicated. Patient or public contribution: People with communication and understanding difficulties and carers participated in a working group to explore, discuss and interpret the findings.

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.

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.