The Mental Capacity Act
The Mental Capacity Act (MCA) applies to everyone who works in health and social care and is involved in the care, treatment or support of people aged sixteen and over, who live in England or Wales and who are unable to make all or some decisions for themselves.
The MCA has five key principles:
- Every adult has the right to make decisions for themselves and it must be assumed that they are able to make these decisions unless it has been shown otherwise.
- People should be supported as much as possible to make a decision before it can be assumed that they have lost capacity.
- Every adult has the right to make decisions that may appear to be unwise or strange to others.
- If a person lacks capacity, any decisions taken on their behalf must be in their best interests.
- If a person lacks capacity, any decisions taken on their behalf must be the least restrictive to their basic rights and freedoms.
A patient's mental capacity can be affected by many factors. Some of these will be only short term whilst others will be long term or permanent effects.
Examples include:
- Brain injury
- Stroke
- Dementia
- Confusion, drowsiness or unconsciousness
- Sedation or anaesthetic
- Substance misuse
- Learning disability
- Urinary tract infection
In Scotland, patients are protected by the Adults with Incapacity (Scotland) Act 2000. The Act allows treatment to be given to safeguard or promote the physical or mental health of an adult who is unable to consent, subject to certain safeguards and exceptions.
In Northern Ireland patients over the age of 16 are protected by the Mental Capacity Act Northern Ireland 2016. The Act considers the patients capacity to make decisions about their health, welfare or finances whilst also safeguarding patients who lack the capacity to make these decisions. The Act presumes that a patient has capacity until proven otherwise. The NI legislation uses two distinct tests to confirm the patient’s ability to make decisions:
- Diagnostic test to determine whether the patient has an impairment or disturbance in the functioning of the mind and /or brain
- Functional test to determine if the patient can understand information and retain it long enough to make a decision and is then able to communicate this decision.
Irrespective of the legislation in place, the principles discussed in this module are relevant to the safe and effective practice of pharmacy in all four countries of the UK.