The Mental Capacity Act: 10 years on – the key learning areas for healthcare professionals

Abstract

The Mental Capacity Act (MCA) became statute law in England and Wales from October 2007 and was described as a visionary piece of legislation for its time, which had the potential to give people a voice and an opportunity to be heard. However, 10 years on, the Act is not being utilized in the UK as was intended. A scrutiny report published by the House of Lords in 2014 1 identified that the MCA was not embedded into the everyday practice of health care professionals due to the lack of knowledge, understanding, and confidence in the application of the basic principles of the MCA in clinical settings. The Department of Health produced a response document, which placed improvements in the implementation of the MCA at the forefront of the political agenda in order to empower and safeguard those deemed the most vulnerable in society. It is envisaged that this response will require a shift in the culture of health care professionals to view the MCA as a mandatory part of clinical practice and not an option. With the prevalence of people with impairment of mind or brain set to rise in the coming years, it is of vital importance that the MCA is used proactively in order to provide a protection for both patients and practitioners.

Evaluation of the MCAST, a multidisciplinary toolkit to improve mental capacity assessment

“…The findings also indicate that professionals felt more confident about their ability to assess capacity when they used the MCAST and they associated their feelings of increased confidence with specific benefits provided by the toolkit. This is a positive outcome because professionals have reported that they lack confidence in their ability to assess capacity, particularly for certain patient groups (e.g., people with communication difficulties) [17,31]. Our finding is consistent with the results of a qualitative investigation of social care professionals' experiences of capacity assessment; these professionals also associated increased feelings of confidence with the use of capacity assessment resources such as documentation proformas [32].…”

A systematic review and narrative synthesis of the research provisions under the Mental Capacity Act (2005) in England and Wales: Recruitment of adults with capacity and communication difficulties

“…Previous reviews have focused on MCA provisions in relation to health and social care practice [ 22 , 43 ] and clinical trials of medicines, which is governed by different legislation (The Medicines for Human Use Clinical Trials Regulations [ 16 ]. Provisions for intrusive research under the MCA have been criticised for a lack of clarity leading to variable interpretations [ 21 , 44 , 45 ]. Considering these challenges, the aim of this systematic review was to develop an understanding of how adults with CDD have been included and accommodated within research studies within England and Wales following the implementation of the MCA, 2005.…”

Restraint in somatic healthcare: how should it be regulated?

“…However, the assessment of decision-making capacity may not always be a matter of black and white, which has been voiced by critics in England and Wales. 42 For instance, what level of decision-making capacity people should have in order to make decisions about their own health is difficult to assess. 42 43 In addition, these difficulties are partly related to the fact that many patients have decision-making capacity regarding certain decisions but not others.…”