Mental Capacity Assessment Guide

MC Assessment: Decision specific and time specific

Simplify and frame the decision in the viewpoint/perspective of the person

e.g. family, friends, carers, GP, LPA, Court Deputy

e.g. interpreter, glasses, pen and paper, hearing aids, consider environment, appropriate time, place, past and present wishes-relevant, Advance Decision to Refuse Treatment (ADRT), written advance decisions

In case the patient regains capacity


Diagnostic Test

Give a bit of background if known, and how the impairment/disturbance impacts on behaviour, circumstances

e.g. dementia, learning difficulty, concussion, confusion, delirium, suspected infection (i.e. UTI), unconsciousness, intoxication due to alcohol/substance misuse, dementia, stroke, learning disability/autism, brain injury, neurological disorders and mental illness etc.


Functional Test

The person must be able to do all of these things to have capacity for the decision.*

Use appropriate language, give as much information as possible about the treatment/decision to be made. Present clear tangible options, benefits and dis-benefits of each option. Have they got an awareness or insight of the treatment/decision?

Recall salient/important information, saying it in the person’s own words

Are they able to see various sides - pros and cons?

e.g. verbal, non-verbal sign language or using the aids supplied

*Please record your discussion separately from questions 1 to 4, explaining why you have reached that decision.


Causative Nexus: Is the person’s inability to make the decision at this time caused by the impairment or disturbance in the functioning of the person’s mind or brain?

Assessors must now evaluate the (in)ability to decide and then consider whether this is because of an impairment


Best Interest decisions

Section 4-5: You do not necessarily need to have a proper meeting. All relevant circumstances must be considered and, in particular, the following steps must be taken:

Refer when person does not have relatives or friends to advocate for them

State the steps taken to enable the patient to take part in making the decision - using person’s preferred method of communication

State all parties who have been consulted in this decision e.g. person, relatives, friends, advocates, LPA, attorneys, carers

State the details of consideration taken to make the decision i.e. past wishes and feelings, beliefs and values, advanced decisions

On basis of age, diagnosis, behaviour etc.

State details of measures taken to ensure decision made is not influenced by anyone motivated to bring about the patient’s death

e.g. POC vs transfer to care home

Best Interest decision chosen - Reason

Best Interest decision not chosen - Reason