1. Mental Capacity Act 2005

2. What are we doing? Discussing the principles of the Act Exploring what is meant by the term ‘Best Interests’ Completing the Capacity Assessment Practicing alternative scenarios Recording our Assessments Sharing our record keeping with each other

3. How we will know that learning has taken place? We will be able to complete a Capacity Assessment by using the checklist We will be able to record the Assessment on ecpa We will be able to plan care for a person who lacks capacity.

4. What do you know about the Act? Think about when we might use it? Consider what we might use it for? What does it help us to decide? Who can determine capacity? How do we actually decide it?

5. Principles of the Act A person must be assumed to have capacity unless it is established that he lacks capacity A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

6. What is meant by ‘Best Interests’? What can you choose for yourself? How do you make those choices? What would you hate for others to choose for you? What do you take for granted? If you were incapacitated who would you like to choose for you? How should we protect you from other people making choices you would hate?

7. Determining Capacity? Does the service-user understand the information? Enough information should be given for the person to make a decision, including alternatives. It should be explained in a way they can understand. The amount of information to be given should be proportional to the complexity of the task. HOW WILL YOU KNOW THEY HAVE UNDERSTOOD?

8. Understanding Understanding is a concept What can you see in this picture?

9. How about these?

10. Capacity Checklist What factors can get in the way of understanding?

11. Capacity Checklist Can they retain the information? There is no legal guidance on amount of information that has to be retained, or for how long. It is useful to ask the service-user to explain how they reached their decision.

12. Capacity Checklist Can they make a balanced decision? Can the service-user weigh up the pros and cons and reach a balanced decision. Their decision can be illogical/irrational or against advice, but it is whether they have used a balanced process in their thinking.

13. Capacity Checklist Can they communicate that decision to you? Can you determine evidence of them making the decision of their own free will, without coercion. If all four are answered yes then regardless of outcome the person is deemed to have capacity

14. Try it out yourselves In two’s practice assessing your partner. Ask them questions and determine whether they have capacity Could they spend all their life savings on an Audi A7 Sport back, rather than putting the deposit on a house? Could they decide whether to have a facial tattoo?

15. Completing the paperwork What else to consider? Temporary or permanent? Previous wishes Family and carer involvement IMCA

16. RECORDING THE ASSESSMENT ON ECPA Myself and the ward manager have spent time with Joe blogs to ascertain whether he has the capacity to spend his life savings on a new car. He was unable to recall the content of the conversation and had to be reminded of the question that we posed on several occasions; his short term memory is extremely impaired and his recall is poor.. He was unable to communicate back to us a rational for wanting the car and he did not appear to understand the consequences of his spending in terms of his future security. He appeared to have no barriers to communication in terms of language or hearing and so we believe that his capacity to make this decision is impaired due to his cognition. We completed a MMSE as part of the assessment and he scored 19 out of 30.He was not orientated to time and place and his recall was poor. He will be unable to drive due to these impairments at the present time and so our recommendation was that it was in his best interest that this particular purchase is deferred. We have completed the best interest assessment and we felt that because his capacity may only be impaired temporarily that we will diary forward to discuss this again within the time frame specified.

17. Recording capacity Myself and the ward manager spent time with Joe today as several staff have approached us stating Joe’s intention to purchase an Audi. He is aware that due to the expense of this purchase that his savings will be depleted and he understands that the costs of insurance and petrol will be prohibitive, which is why he is looking for a second hand model to limit depreciation. He understands that he will have no money left to put towards his future but he has decided not to return to University in September and instead move in with his friends locally until he finds a job. He was able to articulate his needs and he appears to have thought about all the potential benefits and problems with such an expensive purchase. We feel that this has been considered and communicated to us thoroughly and that Joe has capacity to make this decision at this time. We have completed a best interest assessment for his notes.

18. What other decisions could be viewed this way? choices

19. Alternative uses? Physical Intervention Refusing treatment Contraception Breaking confidentiality DOLS Hyperlinks Mental capacity Act 2005 www.legislation.gov.uk/ukpga/2005/9/contents http://www.justice.gov.uk/consultations/docs/cp2307-draft-add.pdf Bournewood Enquiry www.justice.gov.uk/consultations/docs/cp2307-easy.pdf

20. CONCLUSION What have we learned?