MCA in clinical decisions for care and treatment

Assessment of capacity in clinical practice

The Code of practice for the Mental Capacity Act (Department for Constitutional Affairs 2007) is clear that the assessment of mental capacity to consent should be undertaken by the most relevant professional, with the appropriate experience and knowledge of the treatment and care, with the necessary understanding of the legal requirements in the Mental Capacity Act (2005). Assessment of capacity is not only undertaken by senior medical practitioners, psychiatrists or mental health teams; rather the most appropriate professional for the treatment proposed.

It is common for different health and social care professionals to be involved in the assessment of individuals’ mental capacity – where different clinical decisions are being made in different care settings. It is therefore important that multi-professional and multi-agency teams work closely together, to ensure clear communications and collaborative working between professions and agencies, with regards to the assessment of mental capacity of individuals, for different decisions. The mental capacity to give consent to a routine scan or treatment will be very different to that for a complex, high risk procedure with long-term risks and complex options. Practitioners need to be able to make professional judgements as to who is the most relevant person to discuss care and treatment options with the individual, who should be involved in supporting the individual with the decisions needed and who is best placed to assess their capacity to give consent (Grimshaw 2020).

Multi-professional and multi-agency teams must work collaboratively to ensure clear communication and legal practice, and capacity assessments should also involve others who are familiar with the individual, such as family, professional advocates, carers and other health professionals. Where it is thought that an individual may lack mental capacity for a decision regarding serious medical treatment, long-term care needs, safeguarding adult procedures or a care review, an Independent Mental Capacity Advocate (IMCA) must be involved.