Five Principles of Mental Capacity Act

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The Five Mental Capacity Act Principles

The Mental Capacity Act (MCA) 2005 in the UK is built on five important principles to protect and help people who may have trouble making decisions on their own.

The Mental Capacity Act 2005 protects adults aged 16 and older who may have difficulty making certain decisions. It applies to people with temporary or permanent conditions that affect their ability to decide.

The Act assumes that all adults can make their own decisions unless it is shown through an assessment that they cannot.

Also, it says that people should be supported to make their own choices before deciding if they lack the ability. The principles make sure people’s rights are protected and that decisions are made in the person’s best interests.

These five Mental Capacity Act principles are meant to make sure people are treated fairly, with respect, and that the decisions made for them are in their best interest.

We will look at each principle and explain them with practical examples for clearer understanding.

1. Presumption of Capacity

This means “Everyone has the right to make their own decisions.”

Explanation: Every adult is allowed to make their own choices, and we should assume they can, unless there’s clear proof they cannot. Just because someone makes a choice that seems odd or unusual does not mean they cannot decide for themselves.

Example: Sarah has mild dementia and wants to keep living on her own, even though her family is worried. Professionals check to see if Sarah understands the risks and benefits.

Since she can oversee her daily tasks, manage her bills, and take her medication, she shows she is capable of making this decision. Her choice to live alone should be respected, as she has shown she can make this choice safely.

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2. Right to Make Unwise Decisions

The second mental capacity act principle means, “People can make their own choices, even if others think they are unwise.”

Explanation: People can make choices that others might think are wrong or risky. As long as they understand the decision, they have the right to make it, even if others don’t agree. You must understand and respect their freedom of choice.

Example: John is an older man with diabetes. He knows sugary foods are not good for him, but he still chooses to eat them sometimes.

His doctors have explained the risks, and he understands them. Since he knows what could happen, he is allowed to make this choice, even if others might not agree.

As long as John shows he understands what might happen, his right to make this “unwise” choice is respected.

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3. Support to Make Decisions

The third principle of the Mental Capacity Act means: “Provide help to make decisions.”

Explanation: A person should only be seen as unable to make a decision if all possible support has been tried first. This could mean giving information in a simple way, allowing extra time, or choosing a calm place for making the decision.

Example: David, who has learning disabilities, needs to make a decision about a medical procedure. To help him understand, the doctor:

  • Uses simple words and pictures to explain the procedure.
  • Sets up several short meetings instead of one long one.
  • Involves David’s support worker, who knows the best ways to help him understand.
  • Schedules meetings in the morning when David is more alert.

These steps help David make the decision himself by giving him the support he needs.

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4. Best Interests

The fourth principle of the MCA means: “Make decisions in their best interests.”

Explanation: Any decision made for someone who cannot make choices on their own must be in their best interest. The person making the decision should think about what the person would want, their beliefs, values, and what their family or caregivers think is best for them.

Example: Maria has advanced dementia and can no longer tell people where she wants to live. The people making the decision:

  • Look at what she said before about wanting to live close to her family.
  • Read her diary where she wrote about liking gardens.
  • Talk to her family about what she liked in the past.
  • Think about her cultural and religious beliefs.

Based on all this, they decide to choose a care home near her family with a garden, instead of a cheaper one far away.

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5. Least Restrictive Option

The fifth principle of the MCA means: “Keep their freedom as much as possible.”

Explanation: Any decision made for someone who cannot make choices on their own should take away as little of their freedom as possible.

The goal is to pick the best choice that helps them, while still letting them keep as much control over their life as they can.

Example: Tom has autism and anxiety, and he needs help with money decisions. Instead of someone taking full control of his finances:

  • He still has access to his bank account and gets a reasonable amount of money each week.
  • For big purchases, he needs approval from his helper.
  • He can still manage everyday spending on his own.
  • His helper only checks over big financial decisions.

This way, Tom’s money is protected, but he still has as much control over his finances as possible.

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Practical Application:

When using these principles, professionals often follow a two-step test to check if someone can make a decision:

Step 1: Is there a problem with their mind or brain?
Step 2: Can the person:

  • Understand the important information?
  • Remember it long enough to make a decision?
  • Think about the information and make a choice?
  • Share their decision with others?

Example: A Nurse Helping Mrs. Smith Decide About Moving to a New Room

Let’s say a nurse at a care home needs to check if Mrs. Smith can decide if she wants to move to a new room.

Here’s how the nurse might do it:

  1. Explain the Situation
    • Show Mrs. Smith the new room on the upper floor.
    • Explain that the room is closer to the dining room and activities.
    • Tell her the new room has a garden view instead of a street view.
    • Let her know she’ll have new neighbors but can still visit her current friends.
  2. Describe the Benefits and Risks
    • Benefits: Quieter room, better views, closer to things she uses.
    • Risks: It might be hard to get used to the new place, the staff might be different, and she’ll be farther from her current friends.
    • Changes to her daily routine: Meals might be at different times, and she’ll walk a new route to common areas.
  3. Check Understanding
    • Ask Mrs. Smith to explain back what she understands about the move.
    • Make sure she knows she can still visit her friends.
    • Confirm she understands which floor and room she would be in.
    • Verify that she knows she can change her mind during a trial period.
  4. Give Time for Questions and Thought
    • Offer to show the room again at different times of the day.
    • Suggest talking it over with her family.
    • Give her time to think and ask questions. She doesn’t need to decide right away.
  5. Document the Assessment
    • Write down what Mrs. Smith said and how much she understood.
    • Note any concerns or questions she had.
    • Record the way information was shared (e.g., showing pictures, visiting the room multiple times).
    • Write down the final decision and the reasons for it.

Why This Matters

  • The assessment focuses on this particular decision (moving to a new room).
  • Information is shared in small, clear pieces.
  • The person is given multiple chances to understand and ask questions.
  • The whole process is carefully written down.
  • Mrs. Smith’s right to make decisions is respected, and she gets the support she needs.

These steps ensure that Mrs. Smith’s rights are protected, and the decision is made carefully with her best interests in mind.

The five MCA principles help make sure people get the help they need to make their own choices, and that any decisions made for them are fair and kind.

The 4th principle (Best Interests) and 5th principle (Least Restrictive Option) are used when someone is found to not have the mental ability to make a certain decision.

It’s also important to remember that mental capacity can change depending on the decision and the time.

A person might be able to make one decision but not another, and their ability to decide may change over time. This is an important part of the Mental Capacity Act.

🔴Important

Section 5 of the MCA explains that if someone provides care or treatment to a person who can’t agree to it, they can do so without getting into trouble or being held responsible. This provision is important for social care workers and others who help and support people who can’t make decisions for themselves. You can read more on section 5 here.

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