Mental Capacity Act Assessment and Supported Decision-Making Service
Mental capacity is the ability to understand information, retain it, use it to make a decision, and communicate that decision. It is decision-specific, meaning a person may have capacity for some decisions, but not others.
Following a brain change or injury, it is common to experience difficulties that might impact decision-making. We work with clients to provided supported-decision making interventions to provide clients with the opportunity to maximise their decision-making abilities and to support best interest decisions.
We are also specialist providers of Mental Capacity Act Assessments of varying complexity following a brain change or injury.
Which decisions can be assessed?
We can support with the assessment of a number of different types of questions.
We also find that it is helpful to support clients initially with provision of relevant information related to a decision, supported decision-making sessions and consultation with teams around how they might risk assess and support a client where there are concerns about informed decision-making.
Some of the decisions that we can can provide advice, support, and if necessary, formal Mental Capacity Act Assessment for include:
Property and Financial Affairs
Mental Capacity for property and financial affairs involves a person's ability to make decisions about purchasing or selling property and managing all aspects of their finances including day-to-day budgeting or managing large sums.
Health and Welfare
Mental capacity to make decisions about health and wellbeing can be considered as a whole or at a decision-specific level. A person may have capacity for some health decisions but not others. We work with clients and professionals to support best-interest decision making for health if a client lacks capacity.
Sex and Intimate Relationships
Mental capacity to consent to sex and intimate relationships is a complex and sensitive area. It requires careful consideration of legal frameworks and individual circumstances. It focuses on the individual's ability to understand and make choices about a particular sexual act or intimate relationship at that time.
Testamentary (Making a Will)
Mental capacity to make a Last Will and Testament involves understanding the nature of making a Will, the extent of an estate and appreciating who might expect to benefit from a Will (Banks and Goodfellow, 1870).
Online and Social Media Use
Mental capacity regarding social media and internet use is a relatively new and evolving area, but is very important in our digital age. This includes understanding the nature of online content, the risk of exploitation and interacting with strangers. It is crucial to balance an individual's right to online access with their safety and well-being.
Cohabitation
Deciding to live with your partner is a significant decision and one that can requires careful consideration. There are lots of issues to think about when making this decision and we can work with clients to ensure that they have thought these through and made an informed decision.
Litigation Capacity
Mental capacity to litigate understanding understand, participating in, and making decisions within legal proceedings. This might be in relation to family law, civil or, criminal proceedings or Court Of Proceedings.
Accommodation
Mental Capacity to decide a living location or situation involves being able to understand information related to a current living situation, the possible options for accommodation and the pros and cons of each option, including factors such as location, who they might be living with, costs and the support they may need.
Marriage, Divorce or Civil Partnership
Mental capacity to enter into or dissolving a marriage or civil partnership is a common decision and involves comprehending the nature of the relationship, its legal implications, and the responsibilities involved.
If the decision you are concerned about is not listed here, do not worry, we work with clients to assess a broad array of decisions. Please contact us to discuss further.
Mental Capacity Act (2005)
Assessment
Step 1:
Referral
We accept referrals from individuals, families and carers, therapy professionals, case managers, solicitors and financial deputy and Court of Protection Teams.
You can contact us via telephone, email, or using this form to speak to our Clinical Director or Mental Capacity Assessment Service Lead about your enquiry. You will receive efficient, informed advice.
There is no commitment to move forward with an assessment, and we are happy to discuss any queries or concerns that you may have.
Step 2:
Information Gathering
We require an initial referral letter or Letter of Instruction, with background information, reports and any previous MCA assessment documentation.
We will normally aim to understand whether there is a need for additional processes to occur before an MCA assessment is completed, for example gathering evidence or information about a client's current abilities or ensuring that the client has been given all of the necessary information relevant to the decision.
If this is not the case, we may recommend some preliminary work with the client to offer supported-decision making input.
Step 3:
Assessment with Client
We will meet with the client either remotely or face to face, depending on the circumstances and complexity of the case. This may be at their home or in a clinic.
The assessment process involves a conversation about the decision in question and exploration of how the client understands, retains, uses and communicates information related to their decision.
This process may take place over more than one session if the case is considered complex (for example if capacity might be 'borderline' or there are concerns about the Frontal Lobe Paradox) or if there is a concern that capacity fluctuates over time.
Step 4:
Interview with informant
It can often be useful to gather information from those around the client about how they make decisions and the types of decisions that they are involved in.
It is important to hear and consider the views of others about the person's decision-making capacity and to incorporate these views into any reports that are generated.
This might be a family member or friend, or one of the professionals that work with the client.
We can obtain information through collecting documents such as support worker records or previous professional reports, or meeting with a friend, family member or professional remotely or in person.
Step 5 :
Mental Capacity Assessment Report
Depending on the assessment question, purpose of assessment, assessment needs, the complexity of the assessment and client's background and presentation, our clinicians will prepare a detailed and evidence-based report to outline the key findings and recommendations.
Our clinicians are all adept at completing forms for the Court of Protection, including COP3 forms. Where useful, a comprehensive assessment report may also be prepared, inclusive of any functional evidence that has been considered and outlining ongoing recommendations for supported-decision making, risk assessment and internvetion.
Additional Service:
Feedback Session
Our clinicians can provide a feedback session with the client, and anybody who they wish to be present, regarding the assessment outcome. This may be that a person does have decision-making capacity for a specific decision or that they do not.
If a person is deemed to lack capacity, we will provide recommendations about further intervention that might be useful to support them to develop their decision-making skills.
It is common to feel a range of emotions after a capacity assessment and a client may have questions about what this means, We aim to provide a person-centred, collaborative and adapted feedback session to support clients in understand the outcome and next steps.
Additional Service:
Cognitive Assessment
Cognitive assessment involves completion of pen and paper activities with a clinician. and can play a crucial role in capacity assessments by providing objective data on an individual's cognitive functioning, including memory, attention, language, and executive functions, which can help identify difficulties that might impact a person's ability to understand, retain, use and communicate a information in decision-making.
A person can have cognitive impairments and still retain the capacity to make certain decisions. Conversely, a person with seemingly intact cognitive function may lack the capacity to make a particular decision due to other factors. In essence, cognitive assessment is a vital tool within the broader process of evaluating mental capacity.
Intervention and Consultation Services
Supported Decision-Making Interventions
We provide individual supported decision-making sessions to ensure clients are engaged and well-informed around specific decisions and the process of capacity assessment (if required). This includes providing bespoke resource creation to maximise capacity in clinical neurorehabilitation settings.
We also work with professional teams to develop clinical guidelines, supervision and training for multidisciplinary and support teams to ensure clear understanding of how to maximise capacity around decisions occurring routinely in daily life.
Best Interest
Decisions
A "best interest decision" is a concept central to the Mental Capacity Act 2005 (MCA) and applied when a person lacks capacity and someone else must make that decision on their behalf. They are legally obligated to do so in the person's "best interests."
Our clinicians are experienced in supporting and leading 'best interest' decision processes by incorporating the views of all involved, including providing consultation, leading or contributing to 'best interest' meetings and completing 'best interest' decision documentation.
Consultation and Complex Cases
We provide consultation to case management and other professionals around complex decision-making requirements within clinical teams, including but not limited to the Frontal Lobe Paradox, Borderline Capacity Cases and Fluctuating Capacity.
As part of this service we contribution to risk assessments to ensure that an empowerment based and supported decision-making approach is maximised in day-to-day function to avoid the use of overly restrictive or risk averse practices.
Training and Outreach
We provide bespoke training to clinical teams and other professionals in the healthcare industry about best practice for understand decision-making capacity and developing robust supported decision-making protocols within neurorehabilitation to reduce or negate the need for costly formal assessments.
We also deliver bespoke training around issues such as complex cases, borderline capacity, decision-specific assessments, fluctuating capacity and the frontal lobe paradox to healthcare professionals, legal teams and Court of Protection teams.
Neuropsychological Interventions
It can often be the case that during a Mental Capacity Act assessment, different neuropsychological needs are identified.
This might include the need for therapeutic feedback about the outcome of the assessment, brain injury education, 1:1 psychological support or cognitive rehabilitation.
Our Mental Capacity Act Assessors are all Clinical Psychologists and Neuropsychologists who are trained to assess for intervention needs, make recommendations to support a client with emotional and cognitive difficulties that may be impacting decision making, and to deliver these interventions.
Main Clinic: 10 Harley Street, London, W1G9PF
Telephone: +44 (0) 7930243127
Email: Enquiries@Psychologia.co.uk