What is mental capacity?
Everyone should have the right to make choices about their own life. But sometimes injury, illness or disability can limit someone’s capacity to understand complex choices and make decisions.
Someone’s mental capacity could be affected by:
- a brain injury
- a stroke
- a severe learning disability
Every situation is different. In some cases, a person’s mental capacity might only be affected temporarily. Or it may fluctuate over time, meaning that they’re able to make decisions one week but not the next. Or they might be able to make day-to-day decisions about shopping and meals but be unable to make bigger decisions about financial affairs or care options.
Dementia and mental capacity
A person in the early stages of dementia might take longer to communicate, process information and understand choices. But this doesn’t necessarily mean that they have lost mental capacity and can’t make their own decisions.
Mental Capacity Act 2005 (England and Wales)
If the person you’re supporting is finding it increasingly difficult to make decisions, the Mental Capacity Act (MCA) can help. It supports people who want to plan for the future and ensures that their best interests are protected when they lack the mental capacity to make decisions about their care and treatment.
The MCA is aimed at empowering individuals to make their own decisions for as long as possible. It applies to individuals aged 16 and over living in England and Wales. Scotland has its own legislation that covers mental capacity and Northern Ireland has the Mental Capacity Bill.
The MCA covers:
- how to plan for the future
- how mental capacity is assessed
- who can make decisions on someone else’s behalf and what rules they have to follow
It says that:
- it should always be assumed that someone has the capacity to make their own decisions unless they’ve had a capacity assessment that proves otherwise
- individuals should be supported to make their own decisions wherever possible
- any decisions made on behalf of someone else must be in their best interests
Advance care planning
Thinking about the future can be difficult, but if your loved one has an illness (such as dementia) where their ability to make decisions is likely to get worse, planning ahead can help them feel reassured that their wishes will be known and acted on by the people caring for them.
The MCA allows people to set down their wishes for the future in case there comes a time when they are no longer able to make decisions for themselves. Under the MCA people can:
- appoint a trusted person Power of Attorney to make decisions on their behalf should they lack capacity in the future
- write an advance statement expressing their preferences for care and treatment. These are not legally binding but should be taken into account by those considering the person’s best interests
- make an advance decision (also known as a ‘living will’) about certain medical or healthcare treatment that they don't want to receive if they ever lack the capacity to make their own decisions in future. For example, they might not want to receive life-saving treatment in the event of certain illnesses. Advance decisions are legally binding, as long as they meet specific criteria
Who decides if someone has mental capacity?
Under the MCA, a person has the right to make their own decisions until they have been assessed by a health professional as lacking in mental capacity. The health professional will have to consider if the person can:
- understand information related to the decision
- remember information for long enough to make a decision
- weigh up or use the information to reach a decision
- communicate their decision to others, for example by talking, using sign language or hand signals or squeezing someone’s hand
Remember, even if someone is assessed as lacking in mental capacity:
- this might only apply to some, not all, decisions
- it’s not always permanent and they might be able to make their own decisions at a later time
Who can make decisions for someone that lacks mental capacity?
If your family member is assessed by a health professional as lacking mental capacity, someone else will need to make decisions on their behalf.
There are two main options:
A Lasting Power of Attorney: if your loved one appointed a Power of Attorney, this will now come into force. Remember that a Power of Attorney can only be made while someone still has mental capacity.
Deputy: if your family member did not appoint a Power of Attorney, then the Court of Protection will appoint a deputy to make decisions on their behalf. The Court decides who the deputy will be – it might be a trusted relative or friend, or a professional with the relevant skills. You can apply to become a deputy on the gov.uk website. The Court can also decide the length of the appointment and what types of decisions the deputy can or can’t make.
A deputy appointed to make healthcare or personal care decisions on a person’s behalf can decide things such as where they live, the type of care they receive and whether or not they should have medical treatment that doctors consider is in their best interests.
A deputy can’t make a decision that:
- the person has the capacity to make for themselves
- goes against a decision made by an attorney acting under a Lasting Power of Attorney
- they have not been authorised to make by the Court of Protection
- refuses treatment that would help the person stay alive for longer, should they develop a life-threatening medical condition
- the person has already covered in an Advance Decision