Understanding mental capacity: what it is and what to do if someone loses it.

Mental capacity can be a troubling topic for those who work with, or have known people, to suffer from serious mental health problems.

As we continue our Mental Health Awareness Week, Metro.co.uk looks at what mental capacity is.

We also explore how it’s quantified and what happens if someone medically or legally loses mental capacity.

Here is all you need to know.

What is mental capacity?

Mental capacity, at its most straightforward, is the ability to make and understand your own decisions.

The Mental Health Foundation explains that someone lacking capacity cannot do one or more of the following four things:

• Understand information given to them about a particular decision
• Retain that information long enough to be able to make the decision
• Weigh up the information available to make the decision
• Communicate their decision

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What causes a lack of mental capacity?

According to the NHS, a person lacks capacity if their mind is impaired or disturbed in some way.

Whatever it may be, the issue must impair their ability to make a decision at that time.

Examples include:

• Mental health conditions – such as schizophrenia or bipolar disorder
• Dementia
• Learning disabilities (severe enough to impair decision making)
• Brain damage – from injury or a stroke
• Intoxication caused by drug use or alcohol misuse

How is mental capacity assessed?

Before any legal test for mental capacity, the Mental Capacity Act 2005 must be considered.

One of the key principles of the Mental Capacity Act 2005 requires the presumption of capacity, meaning it is assumed that everyone has capacity until proven otherwise.

Therefore, a lack of capacity should not automatically be assumed simply based on a person’s age, appearance, condition or behaviour.

The five key principles of the Mental Capacity Act are:

• Presumption of capacity
• Support to make a decision
• Ability to make unwise decisions
• Best interest
• Least restrictive

Properly assessing a lack of capacity, therefore, will usually be done by an appropriately trained and experienced healthcare professional who’s either:

• Recommending the treatment or investigation
• Involved in carrying it out

As capacity can sometimes change over time, it should be assessed at the time that consent is required.

A person’s capacity can be temporarily affected by shock, panic, fatigue, or medication.

If the healthcare professional feels you have the capacity to give your consent, your decision will be accepted and your wishes will continue to be respected, even if you lose capacity at a later stage.

If the professional feels you do not currently have the capacity to give consent and you have not made an advance decision or formally appointed anyone to make decisions for you, they’ll need to consider what’s in your best interests before making a decision.

Following the principles of the Mental Health Act 2005, it’s important to note is that personal beliefs that may seem illogical from a healthcare point of view don’t always suggest lack of capacity and can go against someone’s best interest.

So, someone refusing a blood transfusion based on religious values might, to some, seem to be making a poor choice. But it is integral that personal beliefs are considered – it would be easy to argue that the person refusing treatment has capacity enough to know the consequences but is choosing to honour their own set of beliefs first.

However, that same argument wouldn’t apply to people with severe eating disorders.

Someone with anorexia, for example, might argue that they’re aware of what they’re doing but they’re choosing to look a certain way.  

Though the arguments might sound similar, someone severely malnourished and rejecting treatment because they refuse to accept there’s anything medically wrong with them would be considered incapable.

What to do if someone loses mental capacity?

If a person knows their capacity to consent may be affected in the future, they can draw up a living will.

This sets out the procedures and treatments that a person refuses to undergo, as well as assigning any financial matters and general decision making.

You can also choose to formally arrange for someone, often a close family member, to have lasting power of attorney (LPA) to make important decisions at a later stage.

Someone with LPA can make decisions about your health on your behalf, although you can choose to specify in advance certain treatments you’d like them to refuse, like in a living will.

If you lose mental capacity and haven’t got a Power of Attorney in place, someone will need to apply to The Court of Protection to become your Deputy and take control of your finances to help you and act on your behalf.

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