The latest case study
The process of assessing mental capacity
Mary, aged 45, suffered a traumatic brain injury due to a car accident in 2008. Due to the injury, she has been left with significant cognitive difficulties, including memory and executive dysfunction. Her family and the professionals involved in her care questioned her ability to make informed decisions in relation to a number of areas of her life.
To assess whether someone has or lacks capacity, they must fulfil certain criteria. Firstly, it must be clear that they have a ‘disorder of mind’ i.e. a specific condition or diagnosis which... more
The process of assessing mental capacity
Mary, aged 45, suffered a traumatic brain injury due to a car accident in 2008. Due to the injury, she has been left with significant cognitive difficulties, including memory and executive dysfunction. Her family and the professionals involved in her care questioned her ability to make informed decisions in relation to a number of areas of her life.
To assess whether someone has or lacks capacity, they must fulfil certain criteria. Firstly, it must be clear that they have a ‘disorder of mind’ i.e. a specific condition or diagnosis which would affect their mental state. Thereafter, 4 areas of their functioning also need to be assessed:
• Understanding of information relevant to make the decision
• Ability to retain the information
• Ability to use or weigh that information as part of the decision making process
• Ability to communicate the decision
Executive dysfunction can affect any of these skills, and so Mary underwent a capacity examination which found her to be unable to retain and weigh up information presented to her due to her memory problems, and marked impulsivity impacting upon her decision making.
Capacity is assessed based on the framework set out by The Mental Capacity Act (England and Wales) 2005, and is assessed by specialists including Clinical Psychologists. Assessment is likely to take the form of interview, psychometric assessment (both general and specific to capacity) in conjunction with clinical notes and liaison with family members and other professionals. The assessing clinician must take into account whether the patient could fulfil the criteria if supported and if so, what the nature and the extent of this support might be.
A consequence of losing capacity to Mary was that her financial affairs had to be taken on by a Deputy under the Court of Protection who would make decisions regarding her finances. This inevitably proved to be quite frustrating for Mary, but necessary as prior to the decision any money given to her as interim payments were spent immediately on items such as a dog, when the client was not able to care for a dog or had expressed no wish to own a dog prior to purchasing it and a car, when Mary was not legally allowed or able to drive. Despite her frustration, the decision removed the stress associated with financial decisions from Mary and her children, enabling improved relationships.
It is also important to consider the need for reassessment and review of all decisions, particularly in cases where a condition is changeable.