Mental Capacity

There is often confusion about who can make decisions about the treatment of someone with a learning disability. Family and carers cannot give consent for another adult. If an adult lacks the capacity to give consent, a decision on whether to go ahead with the treatment will need to be made by the health professionals treating them.

In order to make a decision, the person’s “best interests” must be considered. Family and friends should be consulted in the process of making the decision.

There are many important elements involved in trying to determine what a person’s best interests are, including:

  • Considering whether it is safe to wait until the person can give consent, if it is likely they could regain capacity at a later stage
  • Involving the person in the decision as much as possible
  • Trying to identify any issues the person would take into account if they were making the decision themselves, including religious or moral beliefs; these would be based on views the person expressed previously, as well as any insight close relatives or friends can offer.

GPs should record that the patient has consented to the annual health check. Literature has been produced which can be used as a reminder to help assessing capacity and for information about best interest decisions.

Capacity and consent: tool for health professionals

The General Medical Council (GMC) has launched an interactive online tool to help health professionals determine a patient’s capacity to make a decision about their treatment. The tool draws on principles in GMC guidance and includes downloadable resources including guidance, a flowchart setting out all the steps in the tool, case studies and a record to help the health professional reflect on skills and understanding.

NHS Choices has a page dedicated to consent:

Local independent mental capacity advocate support

If a person is felt to lack capacity, and there is no one suitable to help make decisions about medical treatment, such as family members or friends, an independent mental capacity advocate (IMCA) must be consulted.

North Lincolnshire’s IMCA service is provided by Cloverleaf Advocacy Service:

SCIE Mental Capacity Act Directory

SCIE’s Mental Capacity Act Directory helps to raise awareness about the Mental Capacity Act (MCA), including the Deprivation of Liberty Safeguards. You will find useful information and various tools to help understand or implement it. There is material here for people who may be subject to the Act’s provisions, and for professionals from a range of backgrounds. There are links to leading blogs in this area, as well as to the Social Care Online database of research and journals.