I often hear professionals concerns over the difficulty they have around capacity assessments and really worry about what they are doing. Potentially this could be down to their level of knowledge, experience and learning in this area, however, some of it is down to the language we use when discussing capacity assessments and that we have forgotten what a capacity assessment is.
The reason I say this is because I hear so often, “I’m doing a capacity assessment on this service user/patient….’. If we stop and really look at what is being said here. If we are ‘doing’ something ‘on’ someone, then it doesn’t appear that we are being enabling, engaging and promoting an individual’s autonomy: in other words it doesn’t sound like a nice thing to be involved in. Secondly, what is our mind-set if we are saying this? Are you really thinking that the person has the ability to make this decision? Or is it more likely that you think that the person lacks capacity? And if our frame of mind, our unconscious bias, leads us to think this then we are not following Principle 1 of the MCA – Everyone is assumed to have capacity unless established they lack capacity.
By altering the words we use when thinking about capacity, I think we will find the work we do in this area a bit easier. Because at the end of the day, you are there to support someone to make a decision and you are doing that through having a conversation with them, ensuring that they have all the relevant information, using all available methods of assisting that person to make that decision (Principle 2). Whilst having that conversation, you will be considering the functional test of capacity: can the person you are having the conversation with understand, retain and use/weigh the information that you have provided and can they communicate.
So, if we change our mind-set, change the language we use, it should take some of the worry and fear away. So let’s start saying “I’m off to support Gary make a decision about ….” As we are all well versed and confident in having conversations the interactions we have should be less daunting when it comes to a person’s ability to make a decision. Be enabling, promote autonomy and follow the Principles of the MCA.