L3 MCA v3 November 2020 PDF

Mental Capacity Component 3 © Department of Clinical Education & Standards 1  Objective Understand current legislation, national guidelines & agreed ways of working for undertaking patient assessment and examination. © Department of Clinical Ed...

Mental Capacity Component 3 © Department of Clinical Education & Standards 1  Objective Understand current legislation, national guidelines & agreed ways of working for undertaking patient assessment and examination. © Department of Clinical Education & Standards 2  Mental Capacity - Component 3 Introduction to the legislation Defines capacity Provides a framework for testing capacity Protects those who lack capacity Guides decisions made for people who lack capacity Allows for advance/delegated decisions Covers everyday and life-changing decisions 3  Mental Capacity - Component 3 Who does it apply to? People aged 16 years and over in England and Wales. Exceptions for 16 and 17 year olds: They may not: Make an advance decision Nominate a lasting power of attorney 4  Mental Capacity - Component 3 Code of practice You have a legal duty to have regard for the Code of Practice. 5  Mental Capacity - Component 3 Statutory Principles 1. Presume the person has capacity; 2. Support the person in their decision-making; 3. Do not assume the person lacks capacity simply because they are making an unwise decision; 4. Decisions must be made in the person’s best interests; 5. The least restrictive option should be used. 6  Mental Capacity - Component 3 Assessing capacity – AAP’s can assist only with a mental capacity assessment Time specific & Decision specific  Mental Capacity - Component 3 Two part test: Part 1 – the diagnostic test Is there an impairment of, or disturbance to the mind or brain? 8  Mental Capacity - Component 3 Two part test: Part 2 – the functional test C Can the patient communicate the decision? U Can the patient understand the information needed to make the decision? R Can the patient retain the information long enough the make the decision? E Can the patient employ the information as part of the process to make the decision (use, weigh or appreciate)?  Mental Capacity - Component 3 Impaired capacity At all times the burden of proof is ‘on the balance of probabilities’. If the diagnostic test is met, and a single element of the functional test is met this indicates the patient lacks capacity. A best interests decision should be made.  Mental Capacity - Component 3 Fluctuating Capacity Fluctuating capacity refers to situations where a person’s decision- making ability varies. The person may lack capacity at the time of one assessment, but the result may be different if a second assessment is undertaken during a lucid interval. If capacity is likely to return, consider if it is safe and appropriate to wait  Mental Capacity - Component 36 Fluctuating Capacity There are many different conditions where fluctuating capacity may occur One example is when a person is having an epileptic fit, where they are likely to have a return of capacity once the fit has ceased and the post- ictal period resolved In this instance it would clearly not be appropriate to delay immediate emergency care.  Mental Capacity - Component 3 Best Interests Decisions Consider: Non-discrimination Relevant circumstances Regaining of capacity-can we wait? Encouraging participation Wishes, feelings, beliefs and values The views of others Use LA66 13  Mental Capacity - Component 3 Protection from liability Reasonable assessment of capacity has been made Reasonable belief that the person lacks capacity Reasonable belief that the act is in the person’s best interest  Mental Capacity - Component 3 How to avoid kidnapping s135 and s136 of the MHA are the ONLY legal powers the police have to remove a mentally disordered person to a place of safety for the purposes of assessment. The MCA is not a substitute for MHA. However, the police can assist with manual restraint of a person who lacks capacity, if it is in their best interests. 15  Mental Capacity - Component 3 Lasting Power of Attorney (LPA) Valid & registered? Patient lacks capacity? Subsequent advance decision? Correct type of LPA? Second donee? Is the donee informed? Life-sustaining treatment included? (p6) Decision made in the donor’s best interest? Are the family and carers in agreement? 16  Mental Capacity - Component 3 Need LPA Help? Use the flowchart Use LA068 Available on JRCALC PLUS/the Pulse  Mental Capacity - Component 3 Deprivation of Liberty Safeguards (DoLS) Sometimes people’s freedom must be limited to keep them safe The hospital or care home will apply for DOLS, explaining what liberty should be deprived and why This must be granted by the Court of Protection for the deprivation to be legal In the ambulance setting it would be very rare to deprive a person of their liberty Authorisation would not be required in an emergency, when the priority is to save life.  Mental Capacity - Component 3 Raising Concerns If you are concerned that a person is having their rights & liberties excessively restricted, you should be prepared to raise a concern on the patients behalf. This would be done undertaken as a safeguarding referral.  Mental Capacity - Component 3 Advance Decisions ≥18 years Capacity at the time Refuse a specified treatment If for life-sustaining treatment it must be: In writing Signed and witnessed Clearly state validity when life is at risk 20  Mental Capacity - Component 3 Advance Decisions Not valid if: It has been withdrawn Authority for the decision has subsequently been conferred via an LPA The person has done something clearly inconsistent with the AD remaining a fixed decision It does not meet the procedural requirements of the Act. 21  Mental Capacity - Component 3 Need ADRT Help? Use the flowchart Use LA067 Available on /JRCALC PLUS and the Pulse  Mental Capacity - Component 3 Liability You must follow an AD if you are satisfied that it exists and is valid to the circumstances. You are protected from liability if you are not: -Aware of the AD -Satisfied that it exists, is valid and/ or applicable If you have genuine doubts and ‘reasonably believe’ the legal criteria have not been met you should provide treatment. Document your rationale. 23  Mental Capacity - Component 3 Independent Mental Capacity Advocate (IMCA) The IMCA service is designed to support those particularly vulnerable patients who lack capacity & have no friends or family who could be consulted about important decisions that the patient is no longer able to make. In these circumstances an independent person will be appointed & should be consulted on decisions where possible. However, in an emergency, you should continue to work in a patient’s best interests, if you are unable to contact the relevant dedicated IMCA.  Mental Capacity - Component 3 Report all cases of Use of Restraint restraint on Datix For it to be lawful you must reasonably believe that it is necessary to restrain in order to prevent harm to the person. It must be a proportionate response to the likelihood of harm, and the seriousness of that harm. 25  Mental Capacity - Component 3 Restraint If restraint takes place it must be: The least restriction possible For the shortest possible time You should also monitor the patient for deterioration.  Mental Capacity - Component 3 Documentation is important!! The EPCR Mental capacity checklist is just a recording tool. The important thing is how you conduct the assessment. Document your assessment and your actions clearly.  Mental Capacity - Component 3 Documentation is important!!  Mental Capacity - Component 3 Any questions?