Mental Capacity in Practice

"What good looks like"

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Applying the Principles in Practice via Webinar

Published: Monday 04 January 2021

Support to learn ** Applying The Principles in Practice ** Interested in support to learn and improve, please get in touch **To enquire about training, briefings or support, please contact me at enquiries@mmghealthandsocialcare.com**


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Course Content

Published: Monday 04 January 2021

** Some Course Content ** The content for this resource is large. It is a learning resource and guide to help with understanding and practice and will be made available to the subscriber for up to a year from date of subscription. You can pace yourself, take your time to absorb the learning **Barriers** to implementation of the MCA (Podcast) What do the **SARs** tell us about MCA and What good looks like (Podcast) Suzy Braye Setting the **Context** (Quiz) **What Judges want to see** Principle 1 to Principle 5 (Video) (Alex Ruck Keene) ** Applying Principle 1 in practice ** Exercise **Applying Principle 2 in practice** - Practicable steps guide Melba Gomes - What 'Good' Looks like Gail Dee **Applying Principle 3 in practice** - Case discussion between practitioners (Video) - ** Inherent Jurisdiction** (Video) Alex Ruck Keene - Interview with a client living a **Chaotic Lifestyle** (Video) - Capacity/Unwise decisions/Risk Appraisal (Slides) Melba Gomes - Some ways to work with a person who is making unwise decisions (podcast) Melba Gomes - New Case Added -** Interface MHA/MCA/Care Act** **Principles 4 and 5 in practice** **Capacity Determinations** - What Judges want to see (Video) Alex Ruck Keene **Fluctuating Capacity** - What judges want to see (Video) Alex Ruck Keene **Mental Capacity Assessments and Best Interests Decision Making** **Arthur** Mental Capacity Assessment: Interview (Podcast) and Summing Up (Video)Steve Chamberlene **Linda**: Mental Capacity Assessment (Case study) and Summing Up (Video) Steve Chamberlene **Constance**: Mental Capacity Assessment: Interview (Video) and summing up (Video), also Contrasting Linda and Constance (Video) Steve Chamberlene Constance: Best interests (Video) Steve Chamberlene **Joan** Mental Capacity Assessment: Treatment: Interview (Video) and summing Up (Video) Steve Chamberlene Least Restrictions and **Proportionality** (case example) Melba Gomes


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About the Resource

Published: Monday 04 January 2021

Safeguarding Adult Reviews continue to tell us that compliance with the Mental Capacity Act needs to improve. I wanted to change that. I have known Alex Ruck Keene (a barrister) and Steve Chamberlain (an MCA/MHA expert) for nearly as long as the Act has been in force. In fact we met because of it. I have known Suzy Braye (a professor in social work), in her role as a SAR author. They are equally committed as I am to achieve change and they kindly agreed to contribute to this course, to bring about change. Employers have invested much resource into training staff. In spite of which the staff have mostly been unable to incorporate the learning into their day-to-day work. It seems that they need ongoing support when using the MCA in practice. This resource offers them the opportunity to dip into areas they need support with as and when they need it; as well, to use it as a training resource individually or in groups, team meetings and in supervision. This resource demonstrates the practical application of the principles and also the assessment and best interests process using a variety of media e.g. case scenarios, quiz, worked out examples, acted out scenes, podcasts and videos. In this programme, Alex talks about what judges want to see in relation to the principles. Suzy informs about the gaps in relation to the MCA that she has identified in carrying out Safeguarding Adult Reviews (SAR) and in research that she completed with Michael Preston-Shoot; she gives a good example of the use of MCA in a SAR. Steve provides an analysis of mental capacity and best interests in relation to cases. Gail Dee, a psychologist, outlines a good practice example where ‘practicable steps’ were taken to enable decision making with a person with learning disabilities. Melba Gomes has vast experience of working with people who present with complexities and focuses on 'unwise decision' making and proportionality. I see this resource as the 'go to' place for practitioners to support the application of the MCA to practice. **Once subscribed to, the resource will be available as a guide to refer to as and when needed for up to a year from date of subscription**.


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Using the MCA effectively reduces distress for the person and stress for services

Published: Monday 04 January 2021

The MCA comes into play when a decision has to be made; after all, the first principle emphasises an **adult's right to make autonomous decisions**, a right that can only be infringed if it is **established** (by carrying out a capacity assessment) that the person lacks capacity, followed by a best interests decision based on S4 of the MCA. The MCA is not a stand alone legislation; it sits side by side with one's statutory duties, such as those under the Care Act , Mental health Act and also, ‘Consent to Treatment’. The Act places the person at the centre of decision-making; who they are, their choices, views, their wishes and feelings. These are important considerations in the decision to be made. Inevitably therefore an empathetic conversation has to take place with them. This enables relationship building, hearing them and working together with them to achieve their outcomes, and results in less distress for them, and fewer crises for services. Getting good at using the skills needed to apply the Principles of the MCA can also result in improved outcomes in other areas of work such as Person Centered Care Planning and Positive Risk Taking. Achieving compliance with the MCA now will reduce the impact felt by services when the Liberty Protection Safeguards have to be implemented where all health and social care staff will need to be well equipped with carrying out legally sound capacity assessments


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Children and MCA

Published: Sunday 04 April 2021

I recently attended a training session on mental capacity for staff working with Children and Young People. I sat through the lesson and did not hear anything i did not know from adult MCA work that I have undertaken since 2007. I had to ask the question - am I at the right training? I was told that assessing mental capacity and best interests decision making is no different whether one is an adult or a young person of 16 or 17. There were parents at the course who felt disempowered that they could not interfere with their capacitated child’s decision even where they placed themselves at risk. Their parental instinct is to protect their child. There are some differences in approaches concerning mental capacity in young people aged 16 or 17, and adults A person aged 16 and 17 is by law a minor and their decision may still be overruled by a Court. This has been the case in relation to some decisions regarding refusal of treatment When assessing capacity for children of this age, the assessor must consider that young people are still developing and take care not to mistake mental competence with mental capacity. Young people may not have the level of knowledge to realise the risks associated with a decision; this does not mean that they lack capacity to make a decision. In order to lack capacity, they must have a cognitive impairment or a disturbance in the mind or brain. When considering best interests, different factors will impact, for examples, most young people grow by taking risks, and that they lack capacity should not mean that they are not permitted to take risks to enable their development. Any interventions should be proportionate. Although this point is not exclusively relevant to Young People, it is very important to point out; Young people’s capacity to make a decision, where they have been unable to make a decision, and within which context a decision has been made on their behalf, should be kept under review because where they develop and grow and are enabled through for example, instructions and teaching, they may at a point be able to make their own decision. The trainer was right to say that 1) The test to assess capacity is the same for adults and young people of 16 and 17 years of age and that 2) The best interests process as legislated for in S4 for the Mental Capacity Act is the same for adults and young people of that age Professionals working with Children and Young People will need to become compliant with the Mental Capacity Act in order to ensure the rights of young people are observed and also, to inform their care plans which will in turn support the application of the Liberty Protection Safeguards To learn how to apply the Act to practice you may want to subscribe to our course. Please contact us