Mental capacity

Not a condition, and the most misapplied idea in social care. Capacity is presumed, decision-specific, and time-specific.

What it is

This entry is not a health condition. It is in the library because more harm is done by misunderstanding mental capacity than by most of the conditions listed here.

The Mental Capacity Act 2005 sets five principles, and they are worth knowing in full because they are routinely broken by well-meaning people:

Capacity is presumed. A person is not to be treated as unable to decide unless all practicable steps to help them have been taken. An unwise decision is not a lack of capacity. Anything done for someone lacking capacity must be in their best interests. And it must be the least restrictive option available.

Capacity is specific to one decision at one time. Somebody may lack capacity to manage their finances and have full capacity to decide where they live, or who they see.

Signs you might notice

The warning signs are in the practice, not in the person:

A blanket statement that somebody lacks capacity, with no decision named.

A capacity assessment done once, years ago, still being cited.

An unwise decision treated as evidence of incapacity.

A best interests decision made without consulting the person, their family, or anybody who knows them.

Restrictions in place that nobody has tested against a less restrictive alternative.

How it can affect day-to-day life

Getting this wrong runs in both directions and both are harmful. Assuming incapacity strips somebody of their life, quietly, in a series of small decisions taken on their behalf. Assuming capacity where it is absent leaves a person unprotected.

For people with a learning disability, assumed incapacity is the commoner error and the more damaging one.

For people with Korsakoff syndrome or early dementia, assumed capacity is often the error, because they present articulately and cannot retain what was agreed.

Supporting someone well

Name the decision first. "Does this person have capacity" is not a question that can be answered.

Give every practicable support: easy-read information, the right time of day, a familiar person, AAC if speech is unreliable, and more than one attempt.

Test the four elements honestly: can the person understand the information, retain it long enough to decide, weigh it up, and communicate their decision?

If capacity is absent, run a proper best interests process: the person's own past and present wishes, their beliefs and values, and the views of those close to them.

Choose the least restrictive option, and record why the alternatives were rejected.

Get lasting power of attorney arranged early, while capacity is clear. This is the single most useful practical step a family can take, and it costs far less than a Court of Protection application later.

Fiducia Guardian holds consents, decisions and who holds authority for what, alongside the care plan, so the question "who can agree to this" has an answer that does not depend on whoever is on shift.

Where to get help

The Office of the Public Guardian handles lasting power of attorney and deputyship applications, and their guidance is free.

An IMCA, an independent mental capacity advocate, must be instructed for serious decisions where somebody has nobody else to consult.

Mencap and Alzheimer's Society both produce plain-English guides to the Act.