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MCA information leaflet

Supported Decision Making & Good Practice in Assessing Mental Capacity

 Image of a purple hand with the numbers 1 to 5 on the finger tips. 

  1. A presumption of capacity - start by thinking I can make a decision
  2. The person is supported to make their own decisions  - do all you can to help me make that decision
  3. Unwise decisions - you must not say I lack capacity just because my decision seems unwise
  4. Best Interests  - use a best interests checklist for me if I can’t make the decision
  5. 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?

Afterwards 

Where is your recorded evidence to support conclusions reached?

For example:

‘‘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