The Mental Capacity Act 2005 is a piece of wide-ranging legislation that affects those who care, in any capacity, for people over the age of 16. It details the circumstances where it is possible to make a decision on behalf of someone without the mental capacity to make it themselves, and how the decision should be made. This post will be too short to explain the finer details of the legislation – that’s why we’ve developed a thorough but easy-to-understand course.
Instead, we’ll explain the five key principles that inform the legislation itself. The Mental Capacity Act is built around these principles, so understanding them takes you a long way towards understanding your duties under the law. The CQC is the organisation that enforces these rules, and getting to know them is the key to that treasured ‘Outstanding’ rating.
The Mental Capacity Act isn’t the only big piece of care legislation. We’re also writing a blog post about person-centred care, a term described in the Health and Social Care Act 2008.
The five principles
1) You must assume a service user has the capacity to make decisions about their own care, unless this is proved otherwise.
The first principle establishes that there should be a rigorous test to determine if someone lacks capacity. You must never assume that someone lacks capacity based on their age, appearance, or just the name of their condition, because these can be misleading indicators.
2) If possible, service users should be helped to make their own decisions.
The second principle builds on the first (as does every proceeding principle). Carers must ensure service users have every possible opportunity to make their voice heard in their care. For someone with a deteriorating condition, this could be done by enquiring about someone’s care wishes while they have the capacity to make those decisions.
3) Decisions by service users that carers think ‘unwise’ are still valid.
As a qualified carer, you may feel you know best when it comes to care. Nevertheless, people have their own beliefs, attitudes and needs, and these must be respected under the Act.
4) When it’s been proven beyond doubt that a service user lacks mental capacity, decisions made on behalf of a service user must be made in their best interests.
This fourth principle is seemingly the easiest to understand but is actually a little misleading – because what’s in your ‘best interests’ is often a delicate balance based on history and health needs. For instance, if someone’s life is in danger, it is usually clearly in their best interest to take swift action regardless of their personal wishes.
When the situation is less dire, other things need to be taken into account. In these circumstances, practitioners must use their knowledge of a person, thinking about what they would want if they were able to make the decision themselves, based on their history. As a pleasant side effect, the fourth principle encourages practitioners to get to know service users on a personal level so their wishes can be taken into account.
5) Where possible, the same or a similar goal should be reached in a way that impacts less on a person’s rights and liberty
The final principle is this Act’s ‘backstop’. It requires carers to ask themselves if a course of action that would require a decision on someone’s behalf is necessary at all. While there is often no other alternative to an invasive decision, other avenues should always be explored. Where feasible, a decision could be delayed until a service user has regained the mental capacity to make that decision themselves.
Because the Act is based around these principles, carers who keep them in mind will go a long way towards providing outstanding care.
If you’d like a more detailed grounding in the Mental Capacity Act, and your own qualification, check out Avail’s course, written and endorsed by sector experts.