Hi all,
Just looking for general advice on Capacity Assessments. I have been asked to undertake one for a service user about long term accomodation. However there is conflict with family as to what they want to happen.
Do other social workers feel comfortable doing them? I feel that it should be a health professional although I know in legislation is the decision maker. The conflict for myself is that this will be a long lasting decision and would come back to me if challenged.
Any feedback appreciated!
Thanks
I do a lot of Capacity Assessments and personally, I think that a lot of health professionals are more risk averse although that is a very broad generalisation.
The MCA Code of Practice is very good at taking an assessor through the process.
As for the decision making, that only takes place on someone's behalf if a lack of capacity is established and we must presume capacity.
So there are two parts to the process. Does P have capacity to make a decision about their need for long term care? If yes, they decide, if no, you make a decision in their best interest.
If the family are a potential source of concern regarding their motivations, you may be able to ask for an IMCA to provide a report regarding the best interest decision.
Social Workers have been making these decisions way before the MCA but now it is codified in legislation rather than common law, it can seem that more responsibility is held in ones hand.
As for being challenged, you document everything, follow the specified steps of the assessment and record, record, record the reasons for your decision and you will be legally protected.
I know that doesn't make it less daunting. I've been in the situation you describe many times and sometimes you just really want someone else to make a decision - especially if family oppose. In fact it was under these circumstances I requested an IMCA report even though there was family because I felt it would help me.
And you can/should consult anyone else involved if a best interests decision needs to be made.
Thanks alot for the advice!
I think I just felt a bit overwhelemed as I don't have to do them usually but now i've got my head round it am feeling more confident.
Hello,
We did this interactive guide to mental capacity assessments last year, which was produced in consultation with the Mental Health Foundation.
It's designed to provide a step-by-step guide to deciding whether you should undertake an assessment. Not sure if it will be of help in this context but you may want to have a look at it.
We've just followed this up with a similar guide to cases of self-nelgect.
Cheers,
Mithran
Most SW's I know don't feel entirely comfortable or confident in this area. I recently trained as a BIA and still struggle with the notion of making the best possible decisions. The best thing you can do is gather as much information as you can from all possible sources and place it within the decision making framework the law (including case law) gives you, your employer may have a useful form to guide your thinking. Record very carefully what decisions you have reached and why. The main thing which helped me recently was to look at each relevant factor, decide where that factor led to in terms of 'best option' and then consider what weight I would place on that factor and why. So for instance one important factor is always wishes and feelings of the person concerned - Are they expressing any, what are they, are they consistent, are they totally unaware of their incapacity or do they have some insight, anything that their previous lifestyle and choices/expressed wishes or advance directives which sheds futher light etc. In the instance that the person holds a consistent wish and has insight to their incapacity their view should (according to courts) be given heavier weight than a person with no insight. You can then use this to draw up a sort of table of options and add the weightings of each factor to help with the decision.
Swifty: Hi all, Just looking for general advice on Capacity Assessments. I have been asked to undertake one for a service user about long term accomodation. However there is conflict with family as to what they want to happen. Do other social workers feel comfortable doing them? I feel that it should be a health professional although I know in legislation is the decision maker. The conflict for myself is that this will be a long lasting decision and would come back to me if challenged. Any feedback appreciated! Thanks
Something I've found useful when dealing with the situation you've outlined above is to involve an advocate. Ask them to do the capacity assessment (if you feel it is appropriate), as this makes the decision 'independent'.
Personally, I have struggled with MCAs in the past. Think we all have. But, the more you do, the better you get at them.
'He that is taught only by himself has a fool for a master' - HST.
Here's a MCA situation:
A housing association (HA) owns a property where a care provider provides a supported living-type service to people with -quite severe- learning disabilities. The people have tenancy agreements. The HA needs to replace the washing machine with a high quality one (sluicing etc) that meets people's needs. The cost of this will be covered by the tenants' service charge, which will be raised accordingly the following year. Financially, this doesn't seem to be a problem for the tenants. However, the HA is saying that they have a legal obligation to consult with their tenants about the service charge raise. The care provider is saying that the people don't have the capacity to engage in such a consultation. This is causing a delay to getting the work done. The HA asks how the care provider involves the people they support in other consultations. The care provider and then someone from the local authority's mental capacity team, are saying that the HA should conduct mental capacity assessments with all the tenants at the service.
Aside from the issue of how the people using the service got tenancy agreements in the first place (! historical set up, I presume), does this sound right? Surely the local authority or the care provider would be better placed/more suited to conducting a mental capacity assessment of a person with learning disabilities, rather than a housing officer?
What do people think?