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The Mental Capacity Act

The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make all or some decisions for themselves.

The Mental Capacity Act (MCA) is designed to protect and restore power to those vulnerable people who lack capacity.

About two million people in England and Wales are thought to lack capacity to make decisions for themselves. They are cared for by around six million people, including a broad range of health and social care staff, plus unpaid carers. Those working in health and social care include: doctors, nurses, dentists, psychologists, occupational, speech and language therapists, social workers, residential and care home managers, care staff (including domiciliary care workers), and support workers (including people who work in supported housing).

A lack of mental capacity could be due to:

  • a stroke or brain injury

  • a mental health problem

  • dementia

  • a learning disability

  • confusion, drowsiness or unconsciousness because of an illness of the treatment for it

  • substance misuse

The MCA says that a person is unable to make their own decision if they cannot do one or more of the following four things:

  • understand information given to them

  • retain that information long enough to be able to make the decision

  • weigh up the information available to make the decision

  • communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

Every effort should be made to find ways of communicating with someone before deciding that they lack capacity to make a decision based solely on their inability to communicate. Also, you will need to involve family, friends, carers or other professionals.

If a person has been assessed as lacking capacity then any action taken, or any decision made for or on behalf of that person, must be made in his or her best interests (principle 4). The person who has to make the decision is known as the ‘decision-maker’ and normally will be the carer responsible for the day-to-day care, or a professional such as a doctor, nurse or social worker where decisions about treatment, care arrangements or accommodation need to be made.

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