CAPACITY ASESSMENT

BY
DR SRIVARSHINI SARVABHOWMA
MBBS,DPM,MRCPsych ( LONDON )
Locum Consultant , Bronglais , ABERYSTWYTH
 WHAT IS CAPACITY ?

IT IS THE GENERAL
UNDERSTANDING OF THE
DECISION THAT NEED TO BE MADE
THE ABILITY TO MAKE A
DECISION
 3 QUESTIONS
Does the P has a general understanding of what decisions need to be
1)
made?
Does the P has a general understanding of the consequences of the
2)
decision?
3)Does the P show this general understanding in the way they behave
and make decisions?

 MCA & DOLS

The Mental Capacity Act 2005 (c 9) is an Act of the

Parliament of the United Kingdom applying to England and
Wales . Its primary purpose is to provide a legal framework for
acting and making decisions on behalf of adults who
lack the capacity to make particular decisions for themselves
 5 STEPS

1)IS ABLE TO RECEIVE/UNDERSTAND INFORMATION

2)IS ABLE TO RETAIN INFORMATION
3)IS ABLE TO WEIGH PROS & CONS
4)IS ABLE TO TAKE A BALANCED DECISION (JUDGEMENT )
5)IS ABLE TO COMMUNICATE THEIR DECISION (VERBALLY ) )
 5 PRINCIPLES

1) Assume that P has capacity.

Offer all help & support to make a decision
2)
Unwise decision OK.
3)
Best Interests Principle
4)
Least Restrictive Principle
5)
 DONT ASSUME

The Mental Capacity Act Code of Practice says

that people should not assume that you lack
capacity because of:
your age
your appearance
any mental health diagnosis
any other disability or medical condition
temporary conditions (eg, drunkeness or
unconsciousness),
or any aspect of their behaviour.
MENTAL CAPACITY ACT 2005

The Mental Capacity Act

states that a person lacks
capacity if they are unable to
make a specific decision, at a
specific time, because of an
impairment of, or disturbance,
in the functioning of mind or
 A TWO STAGE TEST

1) Does the person have an

impairment, or a disturbance
in the functioning, of their
mind or brain?
2) Does the impairment or
disturbance mean that the
person is unable to make a
 CAPACITY

Capacity is dynamic and a specific function in

relation to the decision to be taken. This will need
to be regularly assessed in relation to each decision
taken, and carefully documented.

DIFFERENT TYPES OF DECISION

A) LOWER LEVEL OF MENTAL CAPACITY

WHAT TO EAT , WHERE TO GO
B) HIGHER LEVEL OF MENTAL CAPACITY-
BUY A NEW HOME OR GET MARRIED
 CAPACITY

1) PARTIAL OR TOTAL
2) TEMPORARY OR PERMANENT
3) LACK CAPACITY TO ONE SPECIFIC
DECISION AND ABOUT ANOTHER
 EXAMPLE 1

Eva has a mild form of dementia which

affects her short-term memory. After
she spends money, she will often forget
how much she has spent, and whether
or not she has even bought anything.
Her condition is unlikely to improve in
the future.
Eva's capacity to make important
financial decisions has been
 EXAMPLE 2

Paul sometimes hears distressing

voices. He is generally able to do
day-to-day activities, such as
washing, cleaning, and cooking for
himself. However, when the voices
are at their most distressing, he is
not able to do these activities.
Paul's capacity to do day-to-day
 Patient MW

1) Receive / Understand
Information YES
2) Retain Information YES
3) Weighing Pros & Cons YES
4) Balanced decision YES
5) Communicate decision -
 Patient A D

1) Receive understand
information YES
2) Retain information YES
3) Weigh pros & cons NO
4) Balanced decision NO
5) Communicate decision - NO
 Patient DW

1) Receive / Understand
information YES
2) Retain information YES
3) Weigh Pros & Cons NO
4) Balanced decision NO
5) Communicate decision -
Mental Capacity Act says

That someone else can make that

decision for you. Exactly who this would
be depends on the circumstances at the
time, but it could be a:
friend
relative
unpaid carer
paid carer
doctor
Mental Capacity Act says

social worker
nurse
other health care professional
court (in some unusual cases)
Even if someone else is making
decisions for you, you should still
be involved as much as possible
Deprivation of Liberty Safeguards

The Mental Capacity Act

Deprivation of Liberty
Safeguards provides a legal
framework to protect
vulnerable adults, who may
become, or are being
deprived of their liberty in a
What is Deprivation of Liberty?

There is no simple
definition. Deprivation of
liberty is a term used in
the European Convention
on Human Rights about
circumstances when a
Question: Does the person have the capacity to consent to these
arrangements?
ACID TEST

An acid test which should be

applied when determining a
deprivation of liberty:

The acid test states that a person

is deprived of their liberty if:
1) They are subject to
continuous supervision and
Who is eligible for protection
by the DoL Safeguards
The relevant person must:
1) Be aged 18 or over
2) Have a mental disorder ( L D / dementia /
brain injury MI
3) lack capacity ( reg accommodation ).
4) Not be subject to a requirement of the
Mental Health Act, which would conflict with a
DoLS authorisation
5) Not have an advanced decision, or a
decision taken by a done under Lasting
 The DoLS Team

The DoLS team co-

ordinates and manages
the DoLS assessments and
reviews.
1)DoLS co-ordinator
/manager,
How to apply for a DoLS
authorisation
The procedure
The responsibilities of
nursing/social care staf
A ) Is the person being
deprived of their liberty?
B) Do you feel that the
treatment/ and or care is in
that persons best interests?
 THE PROCEDURE

The DoLs team needs to

be contacted to arrange
an assessment by
a registered manager or
provider in a care home
 THE PROCEDURE

Applications to the
Supervisory bodies, via
the DoLS team, for a DoLS
authorisation should be
made by faxing the
required form to safe