Mental capacity assessments are tough

Read my blog for help on this very subjective area of work.

Assessing someone’s mental capacity is not an easy task. Social workers complete mental capacity assessments in a multi-tasked way. They are expected to manage a conversation with the person they are assessing, identify and discuss relevant information to assess their decision making on a particular issue, absorb what is being said by the person, manage other relevant parties that may be present, take notes, decide if a person can make a specific decision, reflect on the outcome of the assessment reached and write it all up in a set recording format.

It is therefore not surprising that social workers still find this assessment task a challenge, regardless of how experienced they may be. Clearly the more articulate the person being assessed the more difficult the assessment because this can result in confusion about whether a particular decision is understood.

The most common mistakes when completing mental capacity assessments, in my opinion, remain:

  • Not robustly defining the decision
  • Not adequately preparing for the assessment
  • Not adequately recording the assessment

Newly Qualified Social Workers
Newly qualified social workers completing their Assessed and Supported Year in Employment are expected to fulfil the ‘Knowledge and Skills Statement for Social Workers in Adult Services’. This includes understanding their responsibilities in applying the Mental Capacity Act in practice. However, are they really being trained and supported to achieve this?

As an Independent Social Worker, I have been supporting newly qualified social workers and social work students. What I have found is that the training provided on the topic of mental capacity both in universities and in social care organisations is varied and lacks a practical approach. The level of experience among social workers in mental capacity is variable as is their confidence.

What some newly qualified social workers have told me is that they have been offered shadowing opportunities with other more experienced social workers in the team and the opportunity to read mental capacity assessments completed by other workers however, this support relies on the level of experience, skill and knowledge of the worker being observed and quality of the recording.

Newly qualified staff reported feeling under pressure to agree with previous mental capacity assessments for a person because they had been completed by a more experienced member of staff. Not all newly qualified social workers I have spoken to described receiving a positive response from more experienced staff and sometimes felt professionally challenged, which in turn knocked their confidence. There is a need to nurture and support newly qualified workers particularly in the area of mental capacity because it is such a difficult area of work and very subjective. There is also a need for ongoing training of qualified social workers in mental capacity allowing them a reflective space to analyse their skills, knowledge and expertise and build upon this going forward.

To support social workers, I provide a practical approach to assessing mental capacity and have broken this down into some key areas as below:

Planning for the Assessment
Before completing a mental capacity assessment, it is essential for social workers to be clear why the assessment is required which will assist them to identify and define the decision required to be made. Prior to the assessment relevant paperwork can be read and consultation with relevant others completed. Relevant information related to the decision needs to be gathered and relevant questions identified. Asking the right questions is key to the mental capacity assessment process and help provide a structure. What, why and how questions help to open conversations and can be mixed with close questions. A discussion about a person’s possible options is also a good way to capture least restrictive alternatives. Wherever possible the best time and location for completing a mental capacity assessment needs to be arranged. There should also be consideration about what practical and any other appropriate support is needed to help a person make a particular decision.


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