Read my blog on mental capacity which discusses key areas which can make these assessments particularly challenging work for social workers and practitioners completing these.
Decision and Time Specific
Mental capacity assessments are decision and time specific however, it can be extremely difficult to practically complete an assessment in one visit. In some cases, the person being assessed may need repeated visits over a short time frame because of their presentation or the complexity of the decision. It may be that the social worker does not know the person at all and needs to see them on several occasions to feel more confident about the assessment process. I recommend visiting a person regularly over a short time frame to gain a picture of their presentation and functioning. This enables a relationship to be built up with a person and see them at different times of the day. It helps to determine what the person can retain from previous visits and see how they manage in their living environment. Once a good understanding of a person has been reached and relevant information gathered to aid the decision a visit can be used to formally complete assessment at a specific time. The information gleaned from previous visits may be very relevant and could be captured in the recording of the decision making to evidence why a particular outcome has been reached. This demands a creative method of recording all the information into a recording format.
Saying Verses Doing
When assessing more articulate people it can be very difficult for social workers to determine if they have understood a particular decision or not. Therefore, information from other sources is important. By gathering other relevant information and consulting with relevant parties, social workers can build a picture about whether a person really does understand the decision to be made. Clearly if a person describes how they manage their money, but the evidence suggests otherwise this is a clear indicator that they really don’t know how to manage their money. This evidence can be put to the person to gain their response. One man I assessed claimed he could manage his money but his correspondence and dialogue with the financial team in social services, regarding his assessed financial contribution to his care costs, suggested otherwise. This information was highly relevant to my assessment, and I included it in the body of my recording to support my assessment outcome.
Unwise Decisions
Social workers have told me that they struggle with deciding when a decision is an unwise decision. I recommend drawing out the risks and consequences posed to the person and presenting these to them during the assessment to determine their level of understanding. In some cases, a person’s condition may lead them to make impulsive decisions even though before acting on the impulse they recognise why they should not do this. When examining if a decision is unwise consultation with relevant others, background information and current circumstances all need to be taken into account. Remember you are basing your assessment on a balance of probabilities. A balance sheet approach can help the assessor separate out responses to help them consider these and come to a reasoned conclusion.