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MCA: Mental Capacity Act Lecture By Linda Uloko RN
Date Posted: 29/Jan/2020
The Mental Capacity Act (MCA) is a law that came into place in 2007 which protects and empowers people who may lack the mental capacity to make personal decisions about their  care and treatment. It applies to people from 16 years and above. 
 
Simply put, the Act aims to empower and protect people who may not be able to make some decisions for themselves. It also enables people to plan ahead in case they are unable to make important decisions for themselves in the future. 
 
Such decisions include day-to-day activities like what to wear or what to buy during shoppings or serious life-changing decisions like whether to move into a care home or have major surgery. 
 
People who may lack capacity include those suffering from; 
• dementia 
• severe learning disability 
• mental illness 
• brain trauma 
• CVA 
• Unconsciousness 
 
Note that, just because an individual is suffering from any of these health conditions doesn't necessarily mean they lack the ability to make a specific decision. 
Someone can lack capacity to make some decisions such as complex financial issues but still have the capacity to make other decisions like deciding on what items to buy from the store. 
 
According to the Act, individuals should be allowed to express their preferences for care and treatment, and to appoint a trusted person (Attorney/advocate) who will make a decision on their behalf should they lack capacity in the future. Also, People should be provided with an INDEPENDENT ADVOCATE who will support them to make decisions in certain situations, such as serious treatment or where the individual might have significant restrictions placed on their freedom and rights in their best interests (DEPREVATION OF LIBERTY). 
 
The MCA says: 
• assume a person has the capacity to make a decision themselves, unless proven otherwise 
• wherever possible, help people to make their own decisions 
• don't treat a person as lacking the capacity to make a decision just because they make anunwise decision 
• if you make a decision for someone who doesn't have capacity, it must be in their best interests. 
• treatment and care provided to someone who lacks capacity should be the LEAST RESTRICTIVE of their basic rights and freedoms 
 
*How is mental capacity assessed?* 
The MCA sets out a 2-stage test of capacity: 
1. Does the individual have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use? 
2. Does the impairment mean the individual is unable to make a specific decision when they need to? 
• People can lack capacity to make some decisions, but have capacity to make others. 
• Mental capacity can also fluctuate with time. An individual may lack capacity at one point in time, but may be able to make the same decision at a later point in time. 
 
>> Where appropriate, people should be allowed the time to make a decision themselves. 
 
*The MCA further states that, a person is unable to make a decision if they can't:* 
a. understand the information relevant to the decision. 
b. retain that information 
c. use or weigh up that information as part of the process of making the decision 
 
>> As a professional, before deciding on whether a person lacks capacity, it's important to take steps to enable them to try to make the decision themselves. 
 
For instance, 
• does the person have all the relevant information they need? 
• have they been given information on any alternatives? 
• could information be explained or presented in a way that's easier for them to understand (like using simple language or visual aids)? 
• have different methods of communication been explored, such as non-verbal communication? 
• could anyone else help with communication, such as a family member, carer or advocate?• are there particular times of day when the person's understanding is better? 
• are there particular locations where the person may feel more at ease? 
• could the decision be delayed until they might be better able to make the decision? 
 
>> If someone lacks the capacity to make a decision and the decision needs to be made for them, it must be in their best interests. 
>> Below is a checklist set out by the MCA for consideration when deciding what's in a person's best interests. 
 
It says you should: 
√ encourage participation – do whatever's possible to permit or encourage the person to take part 
√ identify all relevant circumstances – try to identify the things the individual lacking capacity would take into account if they were making the decision themselves 
√ find out the person's views – including their past and present wishes and feelings, and any beliefs or values 
√ avoid discrimination – don't make assumptions on the basis of age, appearance, condition or behaviour 
√ assess whether the person might regain capacity – if they might, could the decision be postponed? 
 
>> It's vital to consult with others for their views about the person's best interests. In particular, try to consult:* 
> anyone previously named by the individual 
> anyone engaged in caring for them 
> close relatives and friends 
> any attorney appointed under a LASTING POWER OF ATTORNEY OR ENDURING POWER OF ATTORNEY 
> any DEPUTY appointed by the Court of Protection to make decisions for the person 
 
IMPLICATION 
The Mental Capacity Act applies to all professions – doctors, nurses, social workers, occupational therapists, healthcare assistants, and support staff.

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