Mental Capacity Act 2005 Practitioner Level Afternoon session
Housekeeping Toilets Fire Procedure Smoking Mobile Phones / Devices Breaks Finishing Time
Mental Capacity Act QUIZ
The MCA Process Is there a concern about a persons capacity? (with regard to a specific decision) Undertake a Capacity Assessment Or Their own decision (even if we think it is unwise) Best Interest
Principle 4: Best Interest If a person has been assessed as lacking capacity then any action taken, or any decision made for, or on behalf of that person, must be made in his or her best interest. Principle 5: Least Restrictive Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person s rights and freedom of action.
Human and Civil Rights 1948 United Nations Universal Declaration of Human Rights; Adopted by Europe (ECHR) in 1953; Adopted into UK law in 1998 Define the role of the state (Police, NHS, Social Services, care homes and so on) in promoting and protecting our rights Some rights are absolute they must always be protected - but others may be withdrawn or limited in order to protect the rights of others or in times of war or other public emergency threatening the life of the nation
The Right to Life The state has two obligations: 1. Not to take away anyone s life 2.To take reasonable steps to protect life
Right to Private and Family Life, Home and Correspondence The state has a positive obligation to protect these rights. The state should only intervene when necessary to protect a person s other rights Private life: A right to physical and psychological integrity The right to participate in the life of the community The right to form and maintain relationships with other people
The Right to be Free from Torture, Inhuman and Degrading Treatment The state has a positive obligation to protect An absolute right Torture is very severe treatment Inhuman treatment is less severe but still causes severe mental or physical suffering. It does not need to be deliberate Degrading treatment grossly humiliates or is designed to produce feelings of fear, anguish and inferiority
The Right to Liberty Before we had the Mental capacity Act under what circumstances could someone be held / detained against their wishes?
The Right to Liberty You have the right not to be deprived of your liberty arrested or detained except in limited cases. Any action by the state must be proportionate. 1 If you commit a serious crime 2 If you have a mental health problem and pose a risk of significant harm to yourself or others 3. For needs of national security or public safety 4. If you lack the mental capacity to protect yourself from significant harm
Case study Val
Val and Vernon What are your initial concerns about this scenario? What Best Interest Decisions would need to be taken? Please assume that for this exercise appropriate Mental Capacity assessments have been undertaken.
Planning Who would you invite to the Best Interest meeting?
Others Views
Planning What are the key options that might be discussed to support Val with her changing needs and support Vernon?
Tea and Comfort Break
The Decision
Val Refuses To go to the care home To stay at the care home To take her medication
What Are the Options?
Limits of s. 5 decisions Restriction/ Restraint Purpose Duration Intensity Impact Deprivation of Liberty s. 5 Best Interest Decision -> -> -> -> -> -> Deprivation of Liberty Authorisation
What is Restraint? Someone is using restraint if they: Use force or threaten to use force to make someone do something that they are resisting, or Restrict a person s freedom of movement, whether they are resisting or not
Restraint Any action intended to restrain a person who lacks capacity must follow the following two conditions: The person taking action must reasonably believe that restraint is necessary to prevent harm to the said person The amount or type of restraint used and the amount of time it lasts must be a proportionate response to the likelihood and seriousness of harm
Examples of Restraint Chemical Financial Physical Barriers Removal of equipment Preventing contact No communications IT / phone removal Psychological
Case Studies In groups look at the following case studies and decide the legislative and good good practice issues as indicated
Key Points to remember Person much be over 18 Person must lack Capacity Consider; Duration, intensity, impact, purpose Always act in the persons Best Interest not other peoples / organisations Take into account Advanced Decisions
Referral for DL Authorisation The managing authority (the person or body with management responsibility for the care home or hospital where the person is being, or may be, deprived of their liberty) must apply to the supervisory body (the PCT or local authority) for DL authorisation.
Deprivation of Liberty Safeguards Allow the lawful deprivation of liberty of an individual in a care home / residential setting or hospital Lasts for up to 1 year, can be renewed Treatment is not authorised s5 MCA (best interest decision) or the MHA would be needed Authorisation can be suspended for up to 28days to allow treatment under the MHA
Deprivation of Liberty Safeguards Representation A Right of Appeal Opportunity for the Deprivation of Liberty to be reviewed and monitored
DLS Service DLS info line Tel : 01392 381676 dols@devon.gov.uk (signed paper copy will need to follow) DLS / MCA secure fax : 01392 383327 Safeguarding Adults Team, The Annexe, County Hall, Topsham Road, Exeter EX2 4QR. Tel: 01392 382339
Guidance / good practice Social Care Institute for Excellence (SCIE) ADULTS S ERVICES REPORT 25 Minimising the use of restraint in care homes: Challenges, dilemmas and positive approaches
Advocacy Legal right to advocacy for those being assessed for an authorisation and for those detained under one Right to a personal representative (the person can nominate a friend or relative or the supervisory body can nominate a professional e.g. an IMCA) DoLS team will male referral via www.livingoptions.org IMCA service referral form 0845 2311900 - Ring to discuss a referral imca.devon@nhs.net
IMCA service The IMCA service is available for people who do not have an unpaid representative who is willing and able to represent their views. They must be instructed where such a person is considering: Serious medical treatment Hospital admission > 4 weeks A move of accommodation > 8 weeks Care plan reviews They may be instructed for: Deprivation of Liberty Safeguards Assessments Safeguarding Adults investigations
Summary A person centred risk assessment will focus on the outcomes the person wishes to achieve what might be done to help and what obstacles may be removed Workers are not responsible for other people s decisions but they must show what they did to alert a person to the dangers they face and what they did to assist them to manage them A capacity assessment may need to be undertaken to ascertain a person s ability to understand and manage those risks If a person lacks capacity to make a particular decision, a decision will need to be made in their best interest When making decisions for others workers must be able to show what they did and why they did it
Any Questions?
Experience is the name everyone gives to their mistakes. Oscar Wilde, 1854-1900
Useful Websites http://www.devon.gov.uk/index/socialcarehealth /adult-protection/mentalcapacityact.htm www.dh.gov.uk www.publications.parliament.uk www.cqc.org.uk www.scie.org.uk www.scils.co.uk
Evaluation forms