Introduction

The Mental Capacity Act 2005 is relevant to every service working with individuals aged 16 and over who have (or appear to have) difficulty making informed decisions about their care, treatment or support. Health and social care professionals may be unsure of their roles in respect to mental capacity, particularly for end-of-life care and advanced decision making.

This tool seeks to address these issues by embedding knowledge of mental capacity legislation and guidance, underpinned by human rights, into professional education and practice in different care settings. Confusion regarding key terminology is identified as a factor in poor practice including understanding of terms such as best interests.

The sections are ordered to create a narrative, moving from broad concepts and context setting to specific roles and responsibilities, to guide effective practice. You will be encouraged to consider the core principles of mental capacity legislation and the legal framework within which professionals operate which protect the rights of individuals, promote dignity and respect of the person, their beliefs, values and wishes. These elements are key to person-centred care and supportive decision-making which ensure that decisions regarding care and treatment are made in the best interests of individuals at that time.

The Mental Capacity Act 2005 is concerned with the human rights of individuals whose decision-making capacity is impaired. You will be encouraged to reflect on your own personal and professional ethics and values to aid professional decision making.  Core principles of mental capacity legislation and the legal framework within which professionals operate are highlighted: 

• Protecting the rights of individuals 
• Promoting dignity and respect of the person, their beliefs, values and wishes  
• Promoting person-centred care and supportive decision-making which ensure that decisions made are in the best interests of individuals at that time. 
• A presumption of capacity  

This tool will highlight Deprivation of liberty and the Liberty Protection safeguards designed to protect individuals’ human rights. The meaning of consent will be explored and factors affecting capacity to consent to treatment and care are identified underpinned by principles of Autonomy and self-determination and the individual’s right to freedom of choice about the care and treatment they receive.

The tool highlights the role of the Office of the Public Guardian (OPG) (previously the Public Guardianship Office) which was established in October 2007 on implementation of the Mental Capacity Act 2005. The MCA established the role and responsibilities of the Public Guardian supported by the OPG. The importance of Lasting Powers of Attorney (LPS) in supporting individuals whose capacity is compromised is explored alongside consideration of the complex situations which require involvement of the Court of Protection.

The key message of this tool is that effective mental capacity practice requires partnership; that is partnership with the individual, their carers/representatives and with other professionals. It is essential that the views of the individual are supported and promoted however their voice might be expressed. Health and social care professionals may be unsure of their roles in respect to mental capacity, particularly for end-of-life care and advanced decision-making.