Welcome to the Doctor’s MCA toolkit
This is an important resource, designed to support our Doctor’s and responsible clinicians around the application of the Mental Capacity Act. This resource provides a comprehensive guide on assessing mental capacity and making best interest decision, ensuring that practices align with the statutory principles of the act and the highest standards of patient care.
Navigate through the supportive flow charts, detailed terms of reference and practical advice on overcoming common issues and difficulties when assessing capacity. Please also find links to our library of resources, designed to support your work and processes under the MCA and enhance practice and understanding.
Flowcharts
We have created flowcharts to help guide you in Mental Capacity Act, best interest and appropriate decision making. Click on the links below to find out more.
MCA and principles
The MCA provides a legal framework for acting and making decisions on behalf of people who lack capacity.
With detained patients, any decision for a patient that falls outside the scope of the MHA, will be a consent based decision for the patient.
If there is doubt around the person’s capacity to make their own decisions or offer an informed consent or decline, The principals and process of the MCA must be followed.
Capacity assessments are time and decision specific. It is possible for someone to lack capacity to make one specific decision, regardless of complexity, and have capacity to make another decision, again regardless of its complexity. Capacity may also change over time.
The professional who is responsible for assessing capacity on a specific decision, will generally be the person offering that decision and carrying out any subsequent actions.
It is essential to document your assessments of capacity as soon as possible to ensure the most accurate of recording. Assessments also need to be recorded on the trust approved MCA documentation on your clinical system.
The MCA has five statutory principles which must be adhered to.
Always start with the assumption that the patient has capacity to make the relevant decisions for themselves, until it is established otherwise or until you have doubt.
You cannot determine a patient lacks capacity until all practicable steps have been taken to support their decision making. Record and document these efforts. Be clear as to the relevant information for decisions and share the information with the patient in a way they have the best chance to understand, retain, weigh and use. Use reasonable adjustments and supportive tools when and where appropriate.
An unwise decision, even when associated with significant risk, is not sufficient to determine someone lacks capacity. In order for a patient to be making an unwise decision, they must be making it with capacity, therefore understanding their wishes, feelings and rationale is essential in determining doubt and the need for a full assessment.
If a patient is found to lack capacity to make a specific decision, a decision will need to be made as to what is in their best interest. A best interest checklist must be followed.
When doing something to or on behalf of a patient as part of a best interest decision, it is essential to consider if there is a way of achieving the desired goal in a way that is less restrictive on the patient’s rights and freedoms.