Mental capacity legislation in the UK: systematic review of the experiences of adults lacking capacity and their carers.

Sam Wilson

doi:10.1192/pb.bp.116.055160

Abstract

Aims and method Capacity legislation in the UK allows substitute decision-making for adults lacking capacity. Research has explored the experiences of such adults and their carers in relation to the Adults with Incapacity (Scotland) Act 2000, and the Mental Capacity Act 2005 in England and Wales. A systematic review of the relevant research was performed using a framework method.Results The legislation provided mechanisms for substitute decision-making which were seen as useful, but there were negative experiences. Decision-making did not always seem to follow the legislative principles. Awareness of the legislation was limited. Most research was qualitative and some was of low methodological quality. Data were too heterogeneous to allow comparisons between English and Scottish law.Clinical implications Capacity legislation was generally viewed positively. However, some experiences were perceived negatively, and the potential benefits of the legislation were not always utilised.

Highlights

All experiences related to the AWIA and the Mental Capacity Act 2005 (MCA) were considered of interest, from everyday decision-making to perceptions of court proceedings and their outcomes
This review offers a systematic appraisal of the empirical research literature exploring how adults lacking capacity and their carers experience capacity legislation in the UK
Both quantitative and qualitative data were sought in the process of this review, but most of the studies in the ®nal sample used qualitative or mixed methods

Summary

Results

Support workers thought that they needed more training in using the MCA8,16 and were observed to be unclear about some of their duties under the MCA.[9] Guardians in Scotland were ignorant of their responsibilities to document the use of powers, and were unaware that they could delegate them.[15] Some respondents felt that improved sources of information were necessary.[13] Organisations caring for disabled adults had policies about risk which needed to be revised to comply with the principles of the legislation, and education about the MCA was suggested not just for professionals, but for adults lacking capacity and family carers as well.[8]. Many adults lacking capacity participated in the studies in this review (Table 1), the experiences of carers dominated the ®ndings (Table 2)

Method

Methods and limitations

Findings