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How to put the Mental Capacity Act into practice

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The Mental Capacity Act 2005 came into force on 1 April 2007. Martin McGuinness explains how his mental health hospital put the MCA into practice and the benefits to patients


Connolly House is an independent Mental Health Hospital that provides care and treatment for people with serious and enduring mental illness. The Registered Manager and Responsible Person (Director) are accountable and responsible for the standards of care provided and compliance with all legal and care requirements.

The Mental Capacity Act 2005 (MCA) came into force on 1 April 2007. The Act provides a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves, for example those with dementia, learning disabilities, mental health problems, stroke or head injuries who may lack capacity to make certain decisions. The Act will only affect people aged 16 or over.


Before the MCA came into force people who lacked capacity were protected by best practice, common law principles and statutory schemes for Enduring Power of Attorney and the Court of Protection. It is estimated that some 2 million people in the UK may lack capacity to make some decisions for themselves. The Act enshrines in statute current best practice and common law principles concerning people who lack mental capacity.

The whole act is underpinned by a set of five key principles set out in Section 1 of the Act.

1. A presumption of capacity – every adult has the right to make his or her own decisions and must be assumed to have capacity unless it it’s proved otherwise
2. Individuals being supported to make their own decisions
3. Unwise decisions – just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision
4. Only do things or take decisions for people without capacity, in their best interests
5. The outcome of any act or decision should be achieved in the least restrictive way.

The Act also enables forward planning in the form of Lasting Power of Attorney (Replaces Enduring Power of Attorney) and Advance Directives to refuse future treatment.

Implementation and Training

The Director and the Registered Manager led with a series of briefings to staff on the MCA Policy, relevant assessment forms and other documentation. The Training Manager arranged attendance for key staff in the implementation team at external, training and Local Authority ‘train the trainer’ training.

More detailed training was provided for clinical and care staff using Department of Health MCA training set for mental health. Supervision and guidance carrying out capacity assessment in practise was provided by the Registered Manager. All capacity assessments were forwarded to the Director for scrutiny and any that did not meet agreed standards were returned to staff with guidance on correct completion.

Effective inter-agency working

The Registered Manager attends the Local Implementation Network meeting as organisational representative.

Collaborative working by key workers with patients’ CPA Care coordinators in carrying out capacity assessments when decisions have to be made about significant decisions, like change in place of residence.

Referral to and use of the local Independent Mental Capacity Advocates (IMCA) service for patients who meet their criteria. The IMCA service is commissioned by the Local Authorities with PCT partners.

Benefits to Service Users

The MCA, in making a presumption of capacity a legal requirement, firmly puts the service user at the centre of all care planning. All service users must have capacity assessments carried out where decisions need to be made and there is any question about capacity.

In the past there has been a tendency to make assumptions that many patients lack capacity. Since the implementation of the act there have been many significant decision-specific assessments carried out on issues like refusal of medical treatment or refusal to exercise rights under the Mental Health Act.

Several patients required referral to the IMCA service regarding decisions about change of residence to ensure their views were represented and their rights protected.

A wide range of capacity assessments were carried out regarding day to day care decisions and those lacking capacity had care plans developed demonstrating that care was planned and provided in their best interest. Section 5 of the act provides statutory protection from liability for staff performing acts in n connection with care and treatment.

The legal requirements of the Act have had a positive influence on the attitudes of staff to further considering and respecting the rights of service users and involving them in decisions about their care.


The introduction of the MCA in practice has been a challenging and rewarding experience. The fact that there is now a statutory presumption of capacity and the requirement that all acts carried out for those who lack capacity must demonstrably be in their best interests has further changed the culture of healthcare delivery. Staff are now even more conscientious about the rights of the individual to make choices for themselves wherever possible. It is essential to ensure that staff have training, support and supervision to ensure that applying the presumption of capacity becomes everyday practice. Accessing the Local Authority training and support is a valuable resource in achieving this.

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