Abstract

Mental Capacity Assessments have become central to adult social work, as evidenced by the centrality of the issue in reports from the chief adult social worker (Romeo 2017) and in the amount of resources being dedicated to the task. Such assessments are carried out frequently by social workers. In the specialist area of Deprivation of Liberty Safeguards (DOLS) capacity assessments are central and conducting the necessary assessments which are required by these regulations has become a very important and burdensome task for the health and social care system, currently costing over £1 billion per year (Law Commission Impact Assessment 2015).
This paper will present findings from interviews with Best Interests Assessors, DOLS signatories in local authorities, and Mental Health Assessors, about the factors that influence their judgements about mental capacity, based on four brief vignettes presented to them shortly before interview.
We suggest that much of the guidance around the Mental Capacity Act is focussed on a legalistic and procedural approach which suggests that better adherence to existing guidance will lead to the desired outcomes. We will argue that this overlooks the finding from our interviews that normative elements significantly influence judgements about mental capacity and that there needs to be more acknowledgement that values and norms do and should play a part in these deliberations. In that sense a foregrounding of social work values is appropriate and may help practitioners to make sense of what they need to be doing when approaching capacity assessments.

The findings will have relevance to all involved in the DOLS process, but also to social workers and other health and social care staff, who are routinely involved in mental capacity assessments more generally
This paper has particular relevance to the following grand challenged being highlighted at the JUSWEC event.

1.How can social workers support successful ageing and productive longevity? The majority of those who are assessed as lacking the capacity to safely make autonomous decisions are older people with dementia. We will argue that there needs to be more emphasis on the elements of the MCA which refer to supported decision making and methods of maximising autonomy, rather than a simply procedural approach or the paternalistic approach which has continued in much practice according to national reports (House of Lords 2014). This will allow individuals to age with more dignity and autonomy.

References

House of Lords (2014) Mental Capacity Act 2005: post-legislative scrutiny. London.The Stationery Office.

The Law Commission (2015) Mental Capacity and Detention. Impact Assessment 2015. London.The Law Commission.
Romeo,L. (2017) Interim Report by the Chief Social Worker for Adults London Department of Health