Key Questions - Learning disabilities

Key facts for nurses working with people with learning disabilities

Meadhbh Hall, RNLD, DPSN, is healthcare coordinator, Norfolk PCT, and secretary of the National Network for Learning Disability Nurses.

The Mental Capacity Act (2005) aims to protect people with learning disabilities. It provides clear guidelines for carers and professionals about who can take decisions in which situations. It is important that all clinicians who are involved with people with learning disabilities ensure that they follow these guidelines before any treatment is given. All decisions made must be in the best interest of the person.

Will the Mental Capacity Act, which came into force in April 2007, affect the way nurses work?

The Mental Capacity Act will affect all those who work in health and social care who are involved in the care, treatment and support of people aged 16 or over living in England and Wales who are unable to make decisions for themselves. This could be because the person has a learning disability, mental health problem, brain injury or stroke.

What are the key principles of the Mental Capacity Act (2005)?

These are:

• A presumption of capacity;
• Individuals being supported to make their own decisions;
• People have the right to make what might seem to be an unwise decision;
• Treatment should always be in the best interests of the person;
• The least restrictive option should always be considered.

What is mental capacity?

Having capacity means that a person is able to make their own decisions about important aspects of their life, including decisions about health. It is now law under the new act to identify whether the person has the capacity to make their own decisions. To test for capacity practitioners must ensure that the person can:
• Understand the information given to them;
• Retain the information long enough to make the decision;
• Weigh up the information available to make the decision;
• Communicate the decision.

How would you go about testing for capacity?

When undertaking the test for capacity, nurses must ensure that the person is supported as much as possible to help with their understanding. Always use plain English, and avoid jargon or abbreviations. Give the person extra time to think. Consider use of real objects or photographs to help the person with their understanding and to communicate their decision. Also consider visits to clinic areas or the familiarisation of equipment to be used.

What if the person does not have the capacity to consent?

Practitioners need to check if there is an advanced decision in place as this could apply. If not, treatment must always be undertaken in the best interests of the person. Anything done for, or on behalf of, the person without capacity must be in the best interest of the person (principle 4 of the Mental Capacity Act). This process must be undertaken via a 'best interest meeting'. This meeting should involve all relevant parties, including the person, GP and/or doctor, professionals, carers/family, advocate/independent mental capacity advocate (IMCA), and/or people who know them well. All options should be explored, and anything done for or on behalf of a person who lacks capacity should be the least restrictive option. It is important that practitioners accurately record and provide evidence on any decisions made with regards to best interests.

When are IMCAs used?

An IMCA can only be involved when the person lacks capacity and has no relatives or close friends and requires:
• Serious medical treatment, which involves providing, withdrawing or withholding treatment in specific circumstances;
• The NHS to arrange a hospital stay for 28 days or more;
• NHS or local authority to arrange accommodation for eight weeks or more;
• A deprivation or liberty order
• Safeguarding adults procedures.

References and suggested reading

Department for Constitutional Affairs (2007) Making Decisions: A Guide for People Working in Health and Social Care. Booklet 3 in a series of 5. London: DfCA.

Mental Capacity Act (2005)
www.opsi.gov.uk/acts/acts2005/20050009.htm