Mental Capacity Act Code of Practice needs reform, according to new report

Mental Capacity Act Code of Practice needs reform

By Rachel O’Rourke

A new report, compiled by the University of Bristol and The Mental Health Foundation (MHF), has called for the Mental Capacity Act (MCA) Code of Practice to be revised to enable health and social care staff to make better decisions on behalf of mental health patients.

According to the report, mental capacity (referred to in the report as a person's ability to make decisions) has become a much more serious issue in health and social care over the last ten years (certainly since the introduction of the new mental capacity legislation in England and Wales in 2005), with an estimated one million people lacking the capacity to make decisions for themselves - including those with dementia and learning disabilities.

According to the Norah Fry Research Centre at the University and the MHF, "MCA needs revising". The statement from MHF said: "It is essential to make sure that health and social care professionals have the right tools to make effective best interests decisions for people who lack capacity."

Key findings from the report, the result of a two-year research project aiming to deliver evidence about the extent to which the MCA is effective, are:

- A minority of "best interests decisions" were being made for people who had been shown to have capacity having been wrongly assessed as lacking capacity.

- Different ways of making successful "best interests decisions" have been identified which are not currently available to health and social care staff through MCA.

- Health and social care workers admitted that the situations they faced were more complex than is currently reflected in the MCA guidance.

- Lack of awareness of Deprivation Of Liberty Safeguards (a code of practice found within the MCA) was reported in some cases

The report has called for:

 - The MCA Code of Practice to be revised to enable health and social care staff to make more effective "best interests decisions".

- A clearer definition of mental capacity to be included in the MCA Code of Practice

- The development of more case examples to be included in the guidance, about assessment of capacity reflecting the complex real life situations highlighted in the report

- Revision of training materials by the Social Care Institute for Excellence

- Department of Health policies and guidance about other areas of health and social care practice to be updated to reflect changes in the MCA Code of Practice

- All s (including IMCA providers) should be regularly audited for compliance with MCA and DOLS. Compliance by providers of health and social care services should be regularly audited and monitored by the Care Quality Commission

 Head of Development and Later Life at MHF, Toby Williamson, said: "The Mental Capacity Act is a new piece of legislation and it is essential that we make sure that its guidance is effective, reflects the complex situations that health and social care professionals face every day and is easy to put into practice.

"The Code of Practice was written before the Act came into force and we now know from our research that it does not always encompass the complexity of capacity assessments in practice and that staff working in health and social care continue to need support to improve the way that they make best interests decisions. We hope that our recommendation to revise it by reference to our findings will prove a real asset in helping them achieve this." 

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