Mental Capacity Act Research Articles

The unique Singapore medico-legal landscape: impact on advance care planning & end of life decision-making

Death is a taboo subject for many Asians. Singapore's healthcare decision-making laws have been significantly shaped by this consideration given its diverse cultural and ethnic population. Apart from the common...

When the profession becomes personal: dementia care practitioners as family caregivers

Little is known about the impact of caring experience on the practice of dementia care professionals. Few research studies covering dementia practice ask about personal experiences of providing care or having a family member with dementia. In England and Wales, the Mental Capacity Act (MCA) 2005 provided a new legal framework for planning and decision-making in the event of possible loss of capacity. Professional activities in this area include advice and assistance with arranging proxy decision-making, establishing wishes, and advance decisions. The aim of this paper is to present interview data from dementia care professionals with family experiences of dementia and their reflections on decision-making frameworks. A total of 123 dementia care professionals working in community and care home settings were interviewed (2007-2010) about their experiences and expectations of the MCA 2005. Additional questions covered experiences of being family members or carers of a person with dementia and any use of the planning and decision-making provisions of the MCA in personal and family contexts. Data were analyzed thematically. Seventy practitioners had experience of family members with dementia and family caring. Decision-making and planning were viewed as easier under the MCA but tensions could arise around loss of decision-making capacity or family dispute. Empathy for caregiving situations and how things could have been different were reflected upon. Trainers, clinical supervisors, and researchers in dementia care may build upon personal experience of some practitioners to promote empathy with other family carers and the provision of timely information and advice.

Getting the message: intuition and reflexivity in professional interpretations of non‐verbal behaviours in people with profound learning disabilities

Accessible summaryPeople with profound and multiple learning disabilities are often unable to talk to the staff who help to care for them. They rely on non‐verbal communication behaviours to communicate, for example Facial expressions. Gestures. Eye contact. This raises particular challenges for those staff, who include nurses with learning disability nurses. This paper outlines those challenges. They include challenges raised by Person centred planning. The mental capacity act. The need to provide evidence for practice. This paper goes on to suggest ways in which staff can meet these challenges, including the use of skills based on intuition and the use of reflective practice. This paper will help professional staff move towards understanding the NVC of people who have profound and multiple learning disabilities.SummaryThis paper describes the current challenges facing nurses and other professionals who care for people with profound and multiple intellectual disabilities. This particularly vulnerable group of service users often rely on a repertoire of non‐verbal behaviours to communicate their needs and wishes. These challenges include the requirements of Person Centred Planning, the Mental Capacity Act 2005 and the evidence‐based practice movement. Drawing on nursing and some other relevant professional literature, this paper explores the latter in particular and how it relates to the intuitive knowledge base that professionals use to interpret NVC behaviours in this field. It concludes with a discussion of the dangers and limitations of this knowledge and skill base and posits a professional need to discipline its deployment by reflective practice (reflexivity) within well‐established therapeutic relationships. A theoretical example of reflective practice is included.

‘More of a leg to stand on’: Views and usage of the Mental Capacity Act 2005 among staff of local Alzheimer's Society and carer organisations

Objectives: The Mental Capacity Act (MCA) 2005 was implemented in 2007 in England and Wales. It offers new opportunities for people to plan for any future loss of capacity and provides a framework for decision-making on behalf of people lacking capacity. This article explores the challenges staff in local voluntary organisations focusing on dementia and carers face when they offer information and advice connected to possible loss of decision-making capacity to people with dementia and carers. Method: A set of 17 qualitative interviews were undertaken with a purposively sampled voluntary sector staff in London in 2008–09. Framework analysis was used to delineate themes in the transcripts and identified themes were included in the iteratively developed coding framework Results: Interviews revealed that voluntary sector staff generally perceived the Act as largely benefiting people with dementia in the exercise of their rights. They also thought that carers would benefit from the Act's provisions, whilst their own involvement in advice, information-giving and referral to other sources of expertise in relation to the MCA differed according to their role and confidence. Voluntary sector staff's capability and interest in using the MCA vary; there should be no presumption of detailed knowledge, and resources relevant to the MCA might be need to be coordinated more effectively by this sector. Conclusion: Ongoing training, local coordination and auditing seem warranted. These could encompass the new safeguarding provisions of the MCA which may need to be highlighted as part of the welcome extension of rights conferred by the MCA.

What do NHS staff learn from training on the Mental Capacity Act (2005)?

Purpose. Many studies have reported that professionals have a limited understanding of mental capacity issues. Implementation (in England and Wales) of the Mental Capacity Act (MCA) (2005) presents a challenge to services. The aim of this study was to evaluate the extent to which National Health Service (NHS) staff benefited from attending MCA training courses.Methods. Participants were assessed before and after MCA training using a structured interview, which included three scenarios describing mental capacity dilemmas, four vignettes addressing the role of the Independent Mental Capacity Advocate (IMCA), and 16 true–false items.Results. Interview performance improved post‐training, but this could be largely ascribed to an increased awareness of mental capacity issues, with minimal improvements in the knowledge that would be needed to undertake the assessments. Nine areas were identified where there remained significant gaps in participants’ knowledge post‐training. Participants with experience of dealing with mental capacity issues performed better than those without.Conclusions. The results suggest that methods other than formal training events may be needed to prepare health staff to implement new legislation.

Capacity and competence: limitations on choice and action

Purpose – The terms capacity and competence are often used interchangeably, but are actually distinct. This aim of this paper is to clarify the application of these terms, and to illustrate some of the practical benefits of distinguishing them.Design/methodology/approach – The concepts of capacity and competence are discussed in relation to restrictions that are placed on choice and action, respectively, when these qualities are judged to be absent. The paper explores the distinction between these two concepts in relation to their legal status, assessment, and scope.Findings – Mental capacity refers to the ability to make decisions, while competence refers to the ability to perform the actions needed to put decisions into effect. Questions of capacity are governed by legislation (in the UK: the Mental Capacity Act (MCA); the Adults with Incapacity (Scotland) Act and the Sexual Offences Act); they apply only to people who can be demonstrated to have a “mental disorder”, and trigger best‐interests decision ...

Audit of fidelity of clinicians to the Mental Capacity Act in the process of capacity assessment and arriving at best interests decisions

PurposeThe purpose of this paper is to evaluate health professionals' fidelity to the Mental Capacity Act (MCA) principles on determining mental capacity and arriving at best interests decisions in the care of individuals found to lack the relevant decision‐making capacity.Design/methodology/approachA retrospective review of the case records of 68 patients previously determined by clinicians as lacking mental capacity in at least one of three identified areas: treatment consenting capacity, capacity to decide on place of abode and capacity to manage financial affairs, was conducted. Notes were examined to determine how mental capacity was assessed and the process of arriving at best interests decisions in the care of the non‐capacitous individuals.FindingsIt was difficult to locate relevant entries as there were no designated folders for MCA related issues. There were (mostly) minimal entries made about the assessment process, only patchy documentation of the legal criteria used in capacity assessment, and which of the criteria the patient did not fulfil. Clinicians only partially followed the procedure prescribed by the MCA in determining best interests of non‐capacitous patients.Originality/valueThis paper highlights the need for health care professionals to better adhere to the principles of the MCA in assessing mental capacity and in determining the best interests of non‐capacitous individuals. Health care professionals and the public need to be better informed of the provisions of the MCA.

The role of emotion in decision‐making

PurposeThis review of the decision‐making literature aims to challenge the rational model of decision‐making upon which the Mental Capacity Act (MCA) 2005 is premised.Design/methodology/approachThe paper forms part of a larger study commissioned by the Office of the Public Guardian looking into complex cases.FindingsThe literature supported the study findings that decisions are not made in a linear way and identified the importance of history and memory, motivation and drive, mood and stability, and openness to influence when assessing the mental capacity of vulnerable people, especially in the context of self‐neglect.Practical implicationsThis paper will inform workers in health and social care about the emotional factors that influence decision‐making and increase their ability to make nuanced assessments.Social implicationsTaken together, with other publications from this project, this paper alerts practitioners to situations where vulnerable people are out of their depth; when the role of depression and anxiety may be at least as salient as their understanding of possible consequences and when the past may exert more control over their actions than their understanding of future options.Originality/valueThe paper's added value is that it uses ideas that are current within academic psychology to make explicit some of the factors that lead to complexity when assessing mental capacity under the MCA, especially in the context of self‐neglect.

The role of the Office of the Public Guardian in investigations of abuse

PurposeThis paper aims to examine the investigation process employed by the Office of the Public Guardian (OPG). This process is used whenever an allegation of abuse is received against either an attorney acting under a registered lasting or enduring power of attorney or against a deputy appointed by the court of protection to make decisions on behalf of someone who lacks the capacity to make those decisions themselves.Design/methodology/approachCase studies are used to demonstrate both how the investigation process works in practice and how one works in partnership with other organisations to help safeguard vulnerable adults.FindingsThe OPG works in partnership with a range of other relevant organisations to protect vulnerable adults from financial abuse. It details the types of activities, the OPG investigating officer may undertake to examine allegations of abuse and the targets set to help ensure any allegations are investigated promptly and effectively.Originality/valueThe duties bestowed upon the public guardian under the Mental Capacity Act (MCA) 2005, together with a general growing awareness of financial abuse, have had a significant impact upon the work of the investigations team. The case studies included exemplify the kinds of outcomes in cases of abuse and also demonstrate how Attorneys are subject to the same investigative scrutiny as court appointed deputies.

Treating those who are mentally disordered under the Mental Health Act 1983: Part 2

In this second Five-Minute Focus on Law on mental health, we consider how the law deals with the treatment of those who are mentally disordered. Before doing so, it is important to note that it should not be assumed that a person who is mentally disordered under the Mental Health Act (MHA) 1983, as amended by the MHA 2007,1 is necessarily incapable of making decisions about their health. Indeed, in one of the most widely known cases involving a patient who was mentally disordered – Re C (Adult: Refusal of Medical Treatment) [1994] – it was held that a person with paranoid schizophrenia did have the capacity to refuse to consent to his gangrenous leg being amputated.2 It is thus important to distinguish between those who lack capacity and fall within the terms of the Mental Capacity Act (MCA) 2005 because they are unable to make decisions about and for themselves, and those who are mentally disordered within the MHA 1983 and may pose a risk to themselves and others even though they have decision-making capacity. Under the MHA 1983, competent mentally disordered patients have the same right to refuse medical treatment as all other competent patients, but the Act does allow those who fall within its parameters to be treated without their consent in specific circumstances.

‘Early days’: Knowledge and use of the Mental Capacity Act 2005 by care home managers and staff

The Mental Capacity Act (MCA) was fully implemented in England and Wales in October 2007 and has relevance for the care home sector through its focus on decision-specific assessments of capacity. This article reports on research that forms part of a five year programme exploring evidence-based interventions in dementia and this article draws on part of the research that was designed to identify issues relating to implementation of the Act. Specific research questions for this study pertain to staff abilities to incorporate a new legal framework addressing mental capacity into care of people with dementia. Qualitative interviews with 32 staff in one group of care homes in Southern England demonstrated that, regardless of knowledge of MCA, the daily working ethos of staff appeared to be within the remit of Act. Training could therefore continue to build on these principles. However, considerable variation in understanding of terms and principles of the MCA was found. Few participants were aware of specific legislative points and offered ‘common sense’ explanations for their actions and decision-making. This level of knowledge may not meet regulators’ requirements or the needs of residents.

Consent

Failure to provide sufficient information to a patient when seeking consent can result in a claim in negligence. When determining what information to provide, you should be guided by what this particular patient needs to know in order to make an informed decision. Adult patients must be assumed to have capacity to give or withhold consent unless they are clearly unable to comprehend, retain or weigh in the balance the necessary information. Adults without capacity come under the protection of the mental Capacity act (adults with incapacity (Scotland) act in Scotland). as a result, they may when competent have nominated someone to make healthcare-related decisions on their behalf. If nobody has been appointed in this way by a patient it may be necessary to consult an independent mental capacity advocate. An adult with capacity has the right to refuse treatment on rational grounds, irrational grounds or, indeed, no grounds at all.

What do newly appointed health staff know about the Mental Capacity Act (2005)?

The study aimed to assess the extent of knowledge of the Mental Capacity Act (MCA) (2005) among new recruits to a National Health Service (NHS) Trust. Respondents were assessed before and after a brief training experience. Data were collected while respondents attended their mandatory Trust induction training. Assessment was by means of a 16-item true-false questionnaire. While respondents' knowledge appeared reasonably good for some important features of the MCA, these results may have been exaggerated by a strong tendency to respond 'true', which persisted despite instructions intended to counteract it. Some significant areas of ignorance were also identified. Scores showed a small but significant improvement when participants were reassessed following a 10-minute talk on the MCA; the improvements were specific to certain items that were included in the training presentation. There were no significant differences in performance between non-clinical staff, naive clinicians and clinicians who reported having previously received training on the MCA. Knowledge of the MCA among newly appointed NHS staff is patchy, with some strengths but also significant weaknesses. The results demonstrate a benefit of the brief training experience, but also question how much information is retained by participants in MCA training.

The Mental Capacity Act 2005 and its Impact in Critical Care

The Mental Capacity Act (MCA) 2005, covering England and Wales, provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they may lack capacity in the future. The Act came into force during 2007 and applies to everyone ‘habitually resident or present in England and Wales’. Essentially it has translated in to law what has always deemed to be best practice. However it is vital that all healthcare professionals be familiar with the MCA and its accompanying Code of Practice. This article is aimed at those working in the critical care environment and will help to clarify some of the issues raised by the MCA.

‘As People Get to Know It More’: Experiences and Expectations of the Mental Capacity Act 2005 amongst Local Information, Advice and Advocacy Services

Information, advice and advocacy agencies are important providers of information and support to older people in the community. This study explored the role of Age Concern staff across North London in providing timely information and advice relating to advance decision-making should capacity become impaired for a variety of reasons, particularly in relation to the newly implemented Mental Capacity Act (MCA) 2005. Findings suggest that staff had varied knowledge of the MCA and most lacked confidence in providing detailed advice. Given the wide-reaching scope of the MCA, differentiating between information, advice and advocacy may be necessary.

A patient and relative centred evaluation of treatment escalation plans: a replacement for the do-not-resuscitate process

The Treatment Escalation Plan (TEP) was introduced into our trust in an attempt to improve patient involvement and experience of their treatment in hospital and to embrace and clarify a...

Capacity to consent in adults with a learning disability

The Mental Capacity Act (MCA) 2005 puts into statute the legality of interventions in relation to adults who lack capacity. This article explores the issues raised by the implementation of this legislation and focuses on the provision of dental care to people with learning disabilities.

Legal dilemmas for clinicians involved in the care and treatment of children and young people with mental disorder

The 2008 revised Mental Health Act Code of Practice describes the legal framework governing the admission to hospital and treatment of children and young people for mental disorders as complex. Clinicians are required to be conversant with common law principles as well as the Mental Health Act (MHA), Children Act, Mental Capacity Act (MCA), Family Law Reform Act, Human Rights Act, and the United Nations Convention on the Rights of the Child. Professionals working with the MHA and the MCA have a legal duty to have regard to the respective Codes of Practice (MHA Code and MCA Code). In addition there is a need to keep up-to-date with developments in case law. The recent guidance from the National Institute for Mental Health in England, 'The Legal Aspects of the Care and Treatment of Children and Young People with Mental Disorder' draws all of the legal regimes together and suggests pointers on the most appropriate course of action when the regimes overlap. This paper will aim to highlight legal dilemmas relating to the care and treatment of under 18-year-olds for mental disorder and to discuss the impact of these on clinical practice. The new legal framework will be discussed with reference to hypothetical cases. Key issues include age and maturity, capacity, deprivation of liberty and the zone of parental control (ZPC). It is essential that clinicians are aware of their responsibilities within the new legal framework in order to avoid becoming a target for litigation. This paper is aimed at meeting the recommendation for clinicians to be aware of their responsibilities and engage in appropriate training.

Better understanding of the mental capacity act is needed

Better understanding of the mental capacity act is needed

Changes to the Mental Health and Mental Capacity Acts: implications for patients and professionals

SummaryThe new Mental Health Act 2007 for England and Wales has introduced substantial amendments to the 1983 Mental Health Act and has also amended the Mental Capacity Act 2005. Most provisions came into effect in November 2008. the introduction of supervised community treatment, changes to professional roles such as the role of ‘responsible clinician’, and the introduction of deprivation of liberty safeguards in the Mental Capacity Act are discussed. Many of the new safeguards in the Act are welcomed by clinicians and service user groups. However, other changes are more controversial and could potentially lead to an increase in the work load of clinicians.