This case study describes a method of separating and clarifying the impact that a client's concomitant learning disability, personality disorder, bipolar affective disorder and post-traumatic stress each had on her capacity to make decisions and take responsibility. This information was then used to plan an effective management strategy.
Decision-making, mental capacity, responsibility
SINCE THE Mental Capacity Act 2005 came into force, clinicians have had to assess mental capacity more rigorously. The act begins by asserting that individuals are assumed to have capacity unless proved otherwise. It goes on to state that, in each area of life in which important decisions must be made, the capacity of individuals with mental impairment or disturbance to make such decisions must be tested. The act thus enables such individuals to make informed decisions about their lives and to take responsibility for these decisions.
These stipulations have had important repercussions. II' people are responsible for the decisions they make, they are also responsible for the consequences of their decisions. Thus, in accordance with the act, care teams that assess clients' capacity to make decisions can also assess clients' ability to take responsibility.
In some clients, however, the concomitance of learning disabilities and emotional or behavioural problems result in disorders of significantly great severity and complexity (Rock et al 1997). Assessing with as small a margin of error as possible whether capacity is lacking in such clients is difficult.
To overcome this problem, care staff at Cornwall Partnership NHS Foundation Trust developed a system called mental capacity mapping. This involves the separation of an individual's behaviours into different International Classification of Diseases (ICD-10) categories of mental disorder (World Health Organization 2004), followed by the clinical assessment of the individual's mental capacity to take responsibility for the maladaptive behaviours that have emerged from these disorders. Thus, mental capacity mapping relies on the clinical tests of individuals' comprehension of information, and their ability to weigh up options and communicate decisions. It should be noted that mental capacity mapping is not in itself a legal concept but is based on the clinical principles that underpin the legal concept of mental capacity.
A number of 'common law' tests of capacity have evolved over the years and the definition of capacity set forth in the Mental Capacity' Act 2005 may impinge on these 'common law' interpretations.
In discussing how capacity" should be assessed, Craig et al (2007) advise that individuals can be judged to have the capacity to make decisions if they follow a recognisable decision-making process, in which they:
* Know that a decision has to be made.
* Know that they have to make the decision personally.
* Can identify the consequences.
* Can make an assessment of the facts relevant to each decision
* Consider the short-and the long-term consequences of each decision.
* Choose between alternative decisions.
Under the Mental Capacity Act 2005, mental health professionals are encouraged to assume that clients can make decisions until all steps to help them do so have been exhausted without success. As...