Psychology Chartered

Case Studies

Tuesday 12th August 2014

Assessing Mental Capacity

Last year, John (aged 24) from Hampshire had a traumatic brain injury which affected his memory, executive functioning. John was increasingly impulsive and would buy multiple items of something he has seen advertised online even if he didn’t really want them, this has continued excessively and has left John with very little money to partake in his hobbies and buy other essential items. His rehabilitation team were very concerned about his ability to make decisions about his finances and referred John for a capacity assessment.

Capacity is assessed based on the framework set out by The Mental Capacity Act (MCA; 2005), and the assessment is carried out by a specialist Clinical Neuropsychologist using assessment tools, in conjunction with discussions with the individual and their family. Capacity can be re-assessed so a decision is not permanent. There are many area’s that capacity can be assessed for (e.g. financial, medical care, sexual relations) and an individual can be deemed to lack capacity  in relation to some area’s and have capacity  in other areas.

The MCA (2005) outlines that all practicable steps to support the person to make a decision should be considered. To decide whether John has capacity or not, 4 areas of functioning are required:

  1. Understanding of information relevant to make the decision
  2. Ability to retain the information
  3. Ability to use or weigh that information as part of the process
  4. Ability to communicate the decision

John’s executive functioning and memory difficulties meant that he was unable to retain and then use or weigh up information to contribute to his decision making process. At this time he was deemed to lack capacity for decisions regarding his financial affairs.

John’s financial affairs needed to be managed by a legal guardian; in John’s case he had a Deputy who did this. Any decisions that are made by the legal guardian on behalf of the individual must take into account the MCA (2005) guidelines which states that ‘decisions must be made in the individuals best interests …and achieved in a way that is least restrictive to the person’s rights.’ Therefore, John now has money put aside for him to buy items that he needs and wants, to ensure he can go on holidays and partake in the hobbies he enjoys. John does have a finite amount of money each week which he can spend as he chooses which results in the occasional ‘impulsive buy’ but he and his rehab team are reassured that his ‘impulsive purchases’ are no longer at the detriment of other areas of his life, such as his hobbies.