The assessor should contact the person who is being assessed to arrange the best time and place to come and do the assessment. They will also consider the best language to use, the best way to communicate and this should be arranged beforehand. This is where carers, family and friends can be really useful. By law, the person being assessed must be given the best chance of showing they can make the decision.
Sometimes a person may have good times and bad times so they may be visited or assessed more than once in order to give them the best chance to make their own decision. Capacity can also fluctuate; for example, a person’s ability to make a decision about something now may not be the same as in a few weeks’ time. If the decision needs to be made urgently (for example, to be admitted to hospital) the assessor will have to go with what they are presented with at the time and a more thorough assessment must be done once the person is safe.
The assessor will ask the person being assessed if they would like someone to support them. This could be their main carer or other family and friends. If the person being assessed says no and they have the capacity to say no then the assessor will have to abide by this wish. However this does not stop the assessor from speaking to the family to get more information.
Where carers, family and friends are involved in the assessment, they should be aware that the assessor will need to have a private conversation with the person, even if just for a short period. If there are a number of people involved in supporting the person being assessed it is better to nominate one or two people to be involved in the capacity assessment itself as the assessor will not be able to talk to lots of people.
A mental capacity assessment is not the same as a memory test or cognitive test, a statement of a person’s ability to make decisions in the future nor is it used for scoring care needs. It is about making a particular decision here and now.
The assessor will have thought about what are the basic things a person with mental capacity would be expected to know in relation to the particular decision that is being made. Carers, family and friends can prepare for the assessment by thinking about the same things and giving any information to the assessor they feel might be useful. Sometimes the assessor may use information given to them to inform the questions they ask.
The assessor will be looking at whether the person can:
The person being assessed needs to be able to do all of the above.
Day to day decisions may only be recorded in a care and support plan. More formal decisions will be recorded on the person’s medical or social care records depending on who the decision maker is. Once a mental capacity decision has been made it may be changed if the situation changes or if new information is received.
An assessment of mental capacity may require sharing information with others. If a person lacks the mental capacity to consent to share information, it must be decided whether or not it would be in their best interests to do so. Only as much information as is necessary should be divulged.
Someone who have been appointed as a health and welfare Lasting Power of Attorney (LPA) can decide whether information can be disclosed on behalf of the person (the donor). They should normally be consulted before any information is shared. Where it is not possible to consult them (for example, where urgent treatment is necessary) staff must act in the person’s best interests and advise the LPA of actions taken as soon as is practicable.