Mental capacity assessments are essential for determining whether an individual can make informed specific decisions about their life, including decisions about their finances or health. Whilst the majority of people are capable of making these decisions independently, there are circumstances where a person’s mental capacity may come into question. This article explores when a mental capacity assessment might be needed, the key signs to look for, and how the process works.
What is mental capacity?
Mental capacity refers to a person’s ability to make their own decisions. Under the Mental Capacity Act 2005, in England and Wales, a person is considered to have mental capacity if they can understand, retain, and evaluate information related to a specific decision, and then communicate their decision. Mental capacity is both decision-specific and time specific and can vary depending on the complexity of the decision and the information that they are required to understand in order to make that decision, as well as how a person’s cognitive impairment is affecting their ability to make that decision at any given time (linked to fluctuating capacity). This means that someone may have the capacity to make day-to-day decisions but might struggle with more complex matters, such as financial or legal matters.
When is a mental capacity assessment needed?
The starting point of mental capacity is that it should be assumed that a person has mental capacity to make a decision. An assessment of mental capacity should only be sought where there are valid concerns that the person might not be able to make the decision for themselves. These concerns can arise for several reasons, including age-related cognitive decline, medical conditions, or temporary impairments. Below are some common scenarios where a mental capacity assessment might be necessary.
1. Medical conditions affecting cognitive function
Certain medical conditions can impact a person’s ability to understand, retain, weigh and process information and make decisions. Dementia, Alzheimer’s disease, Parkinson’s disease, Stroke and Brain injury are examples of medical conditions that may affect cognitive function. However, it should not be assumed that, just because a person has a diagnosis of such a condition, they are not able to make decisions. Indeed, many people with medical conditions that affect cognitive function are able to make decisions for themselves, particularly when given proper and effective support to do so.
If a loved one is diagnosed with a medical condition that may affect cognitive function, and there are concerns about their decision-making abilities in relation to a specific decision, it may be appropriate to request a mental capacity assessment. The assessment should be a supportive process whereby the person is fully supported to try to make the decision for themselves. This is the approach that we take at TSF Assessments Ltd. Having supported the person to try to make the decision, The mental capacity assessor will then make a decision whether, on the balance of probabiltiies, the person is able to make that decision or not.
2. Changes in behaviour or personality
Sudden or unexplained changes in behaviour or personality may indicate an underlying issue with cognitive functioning. This could include difficulty following conversations, confusion about familiar tasks, or uncharacteristic decision-making. If someone who was once highly organised begins to struggle with basic tasks like paying bills, remembering appointments, or managing their finances, it may be a sign that their mental capacity to engage in these tasks is declining.
In these situations, an assessment can help determine whether the person has capacity to make the specific decision or not, by assessing whether they are able to understand, retain, use and weigh and communicate information relevant to the decision.
3. Mental health issues
Mental health conditions such as schizophrenia, bipolar disorder, and clinical depression can sometimes affect a person’s ability to make decisions. For example, someone experiencing a severe depressive episode may lack the motivation or clarity of thought to make important decisions about their care or finances, meaning that using and weighing information might be difficult for them. Similarly, individuals with severe anxiety may struggle to weigh options when faced with a particular decision.
4. Temporary conditions affecting capacity
Not all impairments affecting mental capacity are permanent. Temporary conditions, such as the effects of medication, acute illness, or the aftermath of surgery, can also affect an individual’s decision-making ability. For example, someone recovering from major surgery may not be in the right state of mind to make complex decisions about their care or finances but once the person has recovered, their capacity may return, allowing them to make decisions independently again.
In such cases, it is important that an assessment of capacity is made at a time best suited to the person, to maximise the possibility that they have capacity to make the decision in question. Of course, there are some decisions that need to be made where it may not be possible to delay the mental capacity assessment, or where (for example in the case of capacity to manage property and finances) the decision is not a “one off” decision but a series of ongoing decisions where the impact of a person’s e.g. fluctuating capacity may need to be taken into account.
Signs that a mental capacity assessment may be needed
It can be challenging to determine when a mental capacity assessment is necessary, especially if the person in question appears to be functioning normally in most areas of their life. However, there are certain signs that may indicate a need for assessment, including:
- Confusion about routine tasks, such as managing finances or paying bills.
- Difficulty understanding conversations or remembering key information.
- Inability to recognise familiar people or places.
- Uncharacteristic decision-making or behaviour, such as impulsive spending or neglecting important responsibilities.
- Problems communicating decisions, either through speech, writing, or gestures.
- Repetitive questions or statements, suggesting an inability to retain information.
If any of these signs are present, it may be necessary to have a mental capacity assessment to determine whether the person can make the decision for themselves.
Significant life decisions
If a person’s ability to make a specific decision is in doubt, a mental capacity assessment will ascertain whether the person is able to make the decision or not. Firstly, the purpose of the assessment is to try and support the person to make that decision. The assessor will consider what the “relevant information” is that the person would need to be able to understand, retain, weigh and communicate, in order to make the decision. They would then ask the person a series of questions relating to the decision in question, whilst supporting them with information needed to make the decision and also supporting them where communication aids might be helpful to maximise their ability to understand the decision- for example, by using pictures, social stories, multi-choice questions, relevant documents, eye gaze technology and BSL or other interpreters. (This is not an exhaustive list!) If a person is able to make the decision for themselves, the assessor would document the assessment process and support given in a report, to evidence how the person was supported to make the decision and why it is considered that they can make the decision for themselves. If the person is not able to make the decision for themselves, again, the assessor would document the assessment process and support given, and this report can then be used, for example, so that family, or health professionals can make health and care decisions in the person’s best interests. In the case of financial decisions, where a person lacks capacity to make a specific decision, an application can be made to the Court of Protection to make (or appoint someone to make) that decision in their best interests.
A mental capacity assessment is a crucial tool for protecting individuals who may be vulnerable due to cognitive impairment. It ensures that their rights are respected, and their decisions are made in their best interests. Whether it’s due to medical conditions, sudden changes in behaviour, or significant life decisions, recognising the signs that an assessment is needed is essential for ensuring proper support and legal protection. If you’re concerned about a loved one’s mental capacity, consider reaching out to qualified professionals, such as those at TSF Assessments, who can provide expert guidance and support throughout the assessment process.
