Mental Capacity and self-neglect
Mental capacity assessments are important because they help ensure that people who may not be able to make decisions on their own get the support they need. The Mental Capacity Act (MCA) provides a framework for assessing mental capacity and making decisions for people who lack the ability to make decisions for themselves.
Learning from the Second national analysis of safeguarding adults reviews, is that in 58% of all reviews, there were concerns about the lack of attention to mental capacity.
The two-stage test
In order to decide whether an individual has the capacity to make a particular decision you must answer two questions:
Stage 1 – Is the person unable to make a particular decision (the functional test)?
Stage 2 – Is the inability to make a decision caused by an impairment of, or disturbance in the functioning of, a person’s mind or brain? This could be due to long-term conditions such as mental illness, dementia, or learning disability, or more temporary states such as confusion, unconsciousness, or the effects of drugs or alcohol (the diagnostic test).
The MCA says that a person is unable to make their own decision if they cannot do one or more of the following four things:
- Understand information given to them
- Retain that information long enough to be able to make the decision
- Weigh up the information available to make the decision
- Communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.
Assessing mental capacity in the context of self-neglect
Whilst the mental capacity tests are well known, assessments can be more difficult where there is a difference between what a person says they will do, and that they are able to do in practice. For example, a person may be able to articulate a plan to address their cluttered environment but be unable in practice to remove any items due to compulsive thoughts of what might happen if they do or be unable to sequence the tasks needed to carry this out.
The following articles may provide helpful in understanding such situation and how this impacts on assessments of mental capacity.
- Local Government Association: Making Safeguarding Personal in self-neglect workbook: See the section; The importance of mental capacity assessment in self-neglect
- Community Care Article: When mental capacity assessments must delve beneath what people say to what they do
- NICE: Assessments of mental capacity
It is important practitioners seek advice from organisational leads around individual assessments and in relation to best practice when undertaking assessments. The articles above are merely intended to support the development of practice and knowledge and to support those conversations with organisational leads.