Supported Decision Making & Good Practice in Assessing Mental Capacity
Image of a purple hand with the numbers 1 to 5 on the finger tips.
- A presumption of capacity - start by thinking I can make a decision
- The person is supported to make their own decisions - do all you can to help me make that decision
- Unwise decisions - you must not say I lack capacity just because my decision seems unwise
- Best Interests - use a best interests checklist for me if I can’t make the decision
- Least restrictive option - check the decision made does not stop my freedom more than needed
Before meeting the person...
Don't forget in preparation to support and assess, consider the following:
- What has prompted this assessment? Be clear about the decision in question
- Have concerns been raised?
- Does the person know of these concerns?
- What has the person already been told?
- What does the person need to know in order to be able to make the decision for themselves?
- Who have you already gathered information from, what is the relevance of this?
- When is the person at their best, for example, time of day and what might help them to communicate with you?
- What communication tools/resources have you considered?
During the conversation verbal or otherwise
When speaking with the person give them time and be patient....
- Does the person know why you are there? Tell them
- Check out at the start what the person already knows
- Give information to them that they need in order to make the decision –tell them what you have gathered and what options are available to them
- Following this you can assess whether they can retain that information, for example, you could say;
‘This is what I know… ..this is why…’
- Asking who, what, where, when, very often checks for knowledge, not understanding
…this could be seen as a test and not helpful if you want the person to engage with you
...avoid jargon and speak plainly
- To gain further detail and extend response use open questions to find out more about a person’s weighing up of the information
- Listen to the person– can you show that they understand?
- Is what they communicate appropriate to the question?
- Probe to elicit more information but remember this is a conversation not an interrogation
- Prompt where necessary
- Ask the person for their opinion
For example, you could say;
- Can you tell me?
- Explain what you mean
- Has that been explained to you?
- Why do you think that?
- Can we go through that again?
- Can you tell me what you understand that to mean?
Where is your recorded evidence to support conclusions reached?
‘‘During the assessment I was able/ unable to prove that ( person’s name) understood…retained…was able to use the information…could communicate.’’
- Write down the person’s responses as evidence
- Support conclusions with evidence in documentation written at the time
Are you acting lawfully?
MCA guidance 1/3
This leaflet contains brief guidance on best practice. For detail, further explanation with evidence and relevant Case Law,
Please refer to further guidance:
2/3 - Assessing Mental Capacity
3/3 - Additional information
All of these guidance notes can be found at the Staffordshire and Stoke-on-Trent Adult Safeguarding Partnership Board website