Health and social care practitioners’ experiences of assessing mental capacity in a community learning disability team

Abstract

Accessible summary The Mental Capacity Act says when and how to assess someone's ability to make a decision and how best to support them to do this. Eight workers in community learning disability teams were interviewed about their experiences of assessing people's ability to make decisions. The workers said that there were a number of areas that they felt were important and which helped them to do good assessments. They also said there were some things that they found difficult. We suggest some changes that could be made to help workers when assessing people's ability to make decisions. It is important to help people make decisions for themselves where they can and to help them when they cannot. Abstract Background: The study explored experiences of health and social care practitioners within a community learning disability team in undertaking mental capacity assessments with people with learning disabilities. Materials and Methods: Eight practitioners were interviewed using a semi‐structured interview schedule. Results: The information gained was analysed using thematic network analysis. Twelve basic themes emerged which fit into five organising themes labelled: ‘systemic barriers to assessment’; ‘capacity assessing as a process’; ‘person‐specific challenges’; ‘protective practices’; and ‘protection of a fundamental human right’. A global theme, ‘freedom of action versus restrictions on action’, was identified. Conclusions: The themes highlighted that there were a range of organisational, systemic and person‐specific factors that impacted on the perceived quality of and assessors’ confidence in their assessments of mental capacity. Furthermore, these factors appeared to create a range of tensions for assessors increasing the likelihood of cognitive dissonance. Practice implications surround maintaining knowledge, ensuring adequate skills in the practical application of knowledge and reducing organisational barriers.

Occupational therapy and decision‐making capacity assessment: A survey of practice in Ireland

“…Given the complexity of DMC assessment, and the significant consequences of such assessments, the ambiguities in guidance of how to implement it in practice are critical (Murrell & McCalla, ) and may affect how occupational therapists engage in this area of practice. Research across a range of disciplines have reported that HCPs find DMC assessment complex and challenging (Aldhous et al, ; Jayes et al, ; Ratcliff & Chapman, ), with gaps in knowledge and skills, time pressures and conflicting practices being cited as issues. Similarly, many respondents in our study reported that they find this aspect of practice more difficult than other areas of occupational therapy practice.…”

“…Respondents in our study highlighted the need for further training in DMC assessment, and the need for practice guidelines to provide a framework for occupational therapists and other HCPs to guide practice in this area, which is consistent with research findings from other jurisdictions and other HCPs (Aldhous et al, ; Seyfried et al, ). However, Ratcliff and Chapman () caution that training may not lead to high‐quality application of the statutory requirements of DMC assessment. A generic one‐size‐fits‐all approach to DMC assessment was not recommended by the therapists in our study, instead the future development of tools, resources and practice guidelines specific to occupational therapy or to particular client groups, may better facilitate the implementation of DMC assessment into routine practice.…”

Exploring the impact of mental capacity on breast screening for women with intellectual disabilities

“…However, it is unknown if staff members would consider undertaking breast screening as a “large” decision, which could determine how rigorously the process is followed. Ratcliff and Chapman () highlighted several challenges around the issue of capacity assessment. A lack of time and resources were the main challenges highlighted, as assessments need sufficient planning and good information gathering.…”

“…Additional challenges centred on working with staff members and families who have a poor understanding of capacity. Ratcliff and Chapman () acknowledged that specific characteristics of the individual can also pose challenges especially if their capacity is considered to be “borderline” or if the individual is overtly influenced by external factors, including support staff. In such cases, there can be indecision or confusion over who is responsible to make the “decision” for the individual.…”

“…In such cases, there can be indecision or confusion over who is responsible to make the “decision” for the individual. In best interest decisions this issue is reduced with joint decision‐making (Ratcliff & Chapman, ; Willner, Jenkins, Rees, Griffiths, & John, ; Willner et al., ).…”