The Mental Capacity Act 2005 was introduced to help to protect vulnerable adults who lack the mental capacity to make decisions for themselves. It contains 5 statutory principles which are designed to support the decision-making process. The first 3 principles relate to establishing a lack of capacity, whereas the final 2 principles relate to steps which should be taken once a lack of capacity is established.
Presumption of Capacity
It should be assumed that an individual has mental capacity, unless it has been proven otherwise. Examples of persons who might lack capacity include; stroke patients, those with dementia, people with a severe learning disability, people with a severe brain injury, or people with a mental health condition. However, having one of these conditions doesn’t automatically mean that the person does not have the mental ability to make their own choices. It is also worth nothing that a lack of capacity may not apply to all decisions. Whilst someone may lack the capacity to make complex financial decisions, they may have the capacity to make less complex choices about their needs. It is also worth noting that a lack of capacity may be temporary. The individual may go on to regain full mental capacity in future.
Supporting Individuals with their Own Decision Making
A person must be given as much help as possible to make their own decisions. This may include changing the format of the information given, so that it is easier to digest. Changing the environment that the information is given in can also make it easier for people to understand the choices. For example, a person may struggle to make a choice in an environment which they consider to be formal and intimidating. Discussing the decision in the clients own home or in a neutral space can improve their ability to understand and retain information. Even if it is established that they lack mental capacity, they should still be involved in the decision-making process, wherever possible.
Unwise Decisions Do Not Denote a Lack of Capacity
It is important for professionals to realise that if a person makes a decision which may be regarded as “unwise” or “eccentric”, this does not necessarily mean that this person lacks mental capacity. The decision may have been made based on the unique beliefs, values and preferences of that individual. If the person is otherwise judged to have the mental capacity required for these decisions, then their “unwise” decision should be respected.
If a capacity assessment finds that a person does lack the mental capacity to make a decision, then someone may be required to make a decision on the persons behalf. Any decision which is made on a person’s behalf must take into account their best interest. Some social workers are trained as Best Interest Assessors to help to maintain appropriate standards. It is worth noting that the best interests of a patient may not always be clear cut. The person who is making the decision should seek to understand the beliefs and values held by the person who is lacking mental capacity. For example, the Assessor or decision-maker should try to take into account any religious beliefs that are held by the individual.
Least Restrictive Option
Any decision which is made on behalf of a person who lacks mental capacity should be designed to restrict their rights and freedoms as little as possible. Steps should aim to prevent harm to the individual or to other individuals; however any actions should allow the individual as much freedom as possible to continue to pursue their own interests and beliefs. Any deprivation of liberties must be justifiable and the least restrictive option available.
How the Mental Capacity Act affects Social Workers
Social workers often work with people who are having trouble coping with social pressures. Some of these individuals may have problems with decision-making or they may make choices which others do not feel are rational or logical. In some circumstances, it may be decided that these people lack the mental capacity which is required to make decisions about their own lives. Capacity may fluctuate and people may be able to make some decisions and not others.
Social workers are often required to play a role in helping to determine whether a client has mental capacity. Because the Mental Capacity Act 2005 is the law in the United Kingdom, social workers must understand it so that they can use the principles effectively. These principles help to protect vulnerable adults. Failing to abide by the guiding principles of the Mental Capacity Act can be a breach of the duty of care towards the client. It may also be considered to be an abuse of power. Any decisions made must be justifiable and can be challenged by the Office of the Public Guardian.