How do health and social care professionals in England and Wales assess mental capacity? A literature review

Abstract

Purpose: To review evidence describing how health and social care professionals in England and Wales assess mental capacity, in order to identify ways to improve practice. Methods: A systematised literature review was completed. Electronic databases of published medical, health and social care research and grey literature were searched. Journal articles and research reports published between 2007 and 2018 were included if they met predefined eligibility criteria. Evidence from included studies was synthesised using thematic analysis. Results: 20 studies of variable methodological quality were included. The studies described assessments carried out by a range of multidisciplinary professionals working with different groups of service users in diverse care contexts. Four main themes were identified: preparation for assessment; capacity assessment processes; supported decision-making; interventions to facilitate or improve practice. There was a lack of detailed information describing how professionals provided information to service users and tested their decisionmaking abilities. Practice reported in studies varied in terms of its conformity to legal requirements. Conclusions: This review synthesised evidence about mental capacity assessment methods and quality in England and Wales and analysed it to suggest ways in which practice might be improved.

Giving voice to people with communication disabilities during mental capacity assessments

“…2017, Jayes et al . 2019). As a result, professionals may unintentionally deprive people with communication disabilities of opportunities to make informed decisions (autonomously or with support), or may ask this group to make decisions that are uninformed and therefore incapacitous (Carling‐Rowland et al .…”

“…Despite this, professionals from other disciplines do not always seek specialist support from SLTs during mental capacity assessments (Jayes et al . 2019). A number of reasons may account for this lack of SLT involvement.…”

“…The rationale for developing a communication screening tool and its content and design specification were identified from the results of a literature review of current mental capacity assessment practice in health and social care (Jayes et al . 2019) and a qualitative exploration of healthcare professionals’ experience of mental capacity assessment (Jayes et al . 2017).…”

“…There is a risk that these types of communication difficulty may mask the true nature of an individual's decision-making ability (Ferguson et al 2010). Professionals without experience of working with people with communication difficulties may make erroneous judgements about these people's mental capacity, based on inaccurate perceptions of their communication abilities, or they may conflate impaired communication with impaired decision-making capacity (McCormick et al 2017, Jayes et al 2019. As a result, professionals may unintentionally deprive people with communication disabilities of opportunities to make informed decisions (autonomously or with support), or may ask this group to make decisions that are uninformed and therefore incapacitous (Carling-Rowland et al 2014).…”

“…The rationale for developing a communication screening tool and its content and design specification were identified from the results of a literature review of current mental capacity assessment practice in health and social care (Jayes et al 2019) and a qualitative exploration of healthcare professionals' experience of mental capacity assessment (Jayes et al 2017). These sources of evidence suggested that the quality of mental capacity assessments would be improved if assessors had a means of collecting dependable information about patients' sensory and communicative abilities and needs, and methods to support these needs, before assessing their mental capacity.…”