Understanding Mental Capacity Assessments: A Guide for Families
When a loved one struggles to make decisions due to illness, disability, or cognitive decline, it can be overwhelming to know what steps to take. The Mental Capacity Act 2005 provides a legal framework in England and Wales to support individuals who may lack the ability to make certain decisions independently. This guide is designed to help families understand what mental capacity assessments are, why they matter, and how to navigate them with confidence and compassion.
What Is Mental Capacity?
Mental capacity refers to a person’s ability to make decisions for themselves. According to the Act, a person lacks capacity if they are unable to:
Understand the information relevant to the decision.
Retain that information long enough to make the decision.
Weigh up the information to reach a decision.
Communicate their decision in any way (speech, sign language, gestures, etc.)
When Is a Mental Capacity Assessment Needed?
Assessments are required when there is concern that someone cannot make a specific decision due to:
Dementia
Learning disabilities
Brain injury or stroke
Mental health conditions
Substance misuse
Temporary confusion or unconsciousness
Importantly, capacity is decision-specific and time-specific. A person may be able to make some decisions but not others, or their capacity may fluctuate over time.
Who Carries Out the Assessment?
Assessments can be carried out by:
Health or social care professionals
Family members (in informal settings)
Legal representatives or deputies (in formal settings)
The assessor must start with the presumption of capacity and provide all necessary support to help the person make their own decision
The Five Key Principles of the Mental Capacity Act
Presumption of capacity – Every adult is assumed to have capacity unless proven otherwise.
Support to make decisions – All practical help must be given before concluding someone lacks capacity.
Right to make unwise decisions – Making a poor decision doesn’t mean someone lacks capacity.
Best interests – Any decision made on behalf of someone must be in their best interests.
Least restrictive option – Actions taken must interfere as little as possible with the person’s rights and freedom
What Happens If Someone Lacks Capacity?
If a person is assessed as lacking capacity, decisions must be made in their best interests. This involves:
Considering their past and present wishes
Consulting with family and friends
Exploring alternatives
Avoiding assumptions based on age, appearance, or condition
Legal Tools for Families
Families may need to consider legal options such as:
Lasting Power of Attorney (LPA) – Allows someone to appoint a trusted person to make decisions on their behalf.
Deputyship – Appointed by the Court of Protection when no LPA is in place.
Advance Decisions – Also known as living wills, these allow people to refuse specific treatments in advance
How Families Can Support the Process
Be informed – Understand the law and your rights.
Be involved – Share insights about your loved one’s preferences and history.
Be proactive – Plan ahead for future decisions.
Be an advocate – Ensure professionals follow the Code of Practice and respect your loved one’s dignity
Final Thoughts
Mental capacity assessments are not just legal procedures—they are about protecting the rights, dignity, and autonomy of vulnerable individuals. As a family member, your role is vital in ensuring decisions are made with care, respect, and compassion.
If you need further guidance, resources like the Mencap Mental Capacity Act Resource Pack and the ELFT Guide for Family Carers are excellent starting points.