Mental Capacity in Waltham Forest

The Mental Capacity Act 2005 (MCA) is a vital piece of legislation, which makes a real difference to the lives of vulnerable people in England and Wales.

The Mental Capacity Act (2005) supports people in the following ways:

• Empowering residents to make decisions for themselves wherever possible
• Protecting those who lack capacity by placing them at the heart of the decision-making process
• Ensuring that residents participate as much as possible in decisions made on their behalf, and these decisions are made in their best interests
• Allows residents to plan ahead, in case they might lack capacity in the future for any number of reasons, to make decisions for themselves

All professionals who work within the health and social care sector have a duty to comply with the Mental Capacity Act, alongside their local authorities’ specific policies, procedures and regulatory requirements.

Waltham Forest's Mental Capacity subgroup has worked closely with practitioners to create usable guidance for professionals working with vulnerable adults, in order to support the application of the Mental Capacity Act. The document contains flow charts on ‘best interests’ decisions, advice on fluctuating versus temporary capacity, and more.

The updated multi-agency Mental Capacity Guidance contains information and case studies to guide professionals in routes to supporting residents with fluctuating capacity due to substance abuse, as well as support for voluntary carers in how to make decisions on behalf of people who can’t act or make those decisions for themselves.

• Updated Mental Capacity Guidance
• 7 Minute Briefing for Mental Capacity 
• View the mental capacity training on Waltham Forest’s YouTube channel 
• General information and resources related to the Mental Capacity Act from Social Care Institute for Excellence
• Short film on Liberty Protection Safeguards
• Carers guide to mental capacity
• A guide to mental capacity for family, friends and unpaid carers

Filmed resources on Mental Capacity

• Mental Capacity Act Overview and the National Mental Capacity Forum
• Introduction to using the Mental Capacity Act
• Using the MCA key principles in care planning

Explanations of terms and definitions:

ADRT or Advance Decision to Refuse Treatment: A refusal of a treatment that may be required in the future, made by someone who had mental capacity to make that decision at the time the decision was made. It is legally binding if it is valid and applicable.

Advance Statement: This is a statement of wishes, preferences, values and beliefs. It is not legally binding but should be considered when making a best-interests decision for someone who lacks capacity to make that decision for themselves.

Court Appointed Deputies: Individuals appointed by the Court of Protection to act on behalf of adults who lack capacity and make decisions on their behalf about health and welfare and/or property and finance.

Human Rights Act 1998: The act sets out the fundamental rights and freedoms that everyone in the UK is entitled to. It incorporates the rights set out in the European Convention on Human Rights (ECHR) into domestic law.

IMCA or Independent Mental Capacity Advocates: Independent Mental Capacity Advocates were introduced as part of the MCA. This gives people who lack capacity to make certain decisions for themselves, the right to receive independent support and representation. Please see the MCA Code for full details on when an IMCA might be required.

Lasting Power of Attorney (LPA): This allows an adult to appoint a person(s) to make decisions on their behalf in case they lack capacity to make a decision for themselves at some time in the future. There are two types of LPAs:

1. Health and Welfare
2. Property and Financial Affairs

Life-sustaining Treatment: This is any medical intervention, technology, procedure, or medication that a person providing healthcare regards as necessary at the time in question to sustain life.

SAR or Safeguarding Adult Review: This is a multi-agency process that considers whether serious harm experienced by an adult or group of adults at risk of abuse or neglect, could have been predicted or prevented. The process identifies learning that enables the partnership to improve services and prevent abuse and neglect in the future.

Independent mental capacity advocate (IMCA) services support residents who cannot make or understand decisions by stating their views and wishes or securing their rights.

This guidance explains:

• What advocacy is
• The role of an IMCA
• How the IMCA service works in practice
• Who will benefit from the IMCA service?
• How to make a referral to the IMCA service

Making decisions: The Independent Mental Capacity Advocate (IMCA) service (PDF)

Below are some of the Mental Capacity case studies: 

• Assessing mental capacity for after care, where dementia present_Patricia
• Assessing mental capacity in case of medical after care_Murat
• Assessing mental capacity in relation to taking medicine_Raymond
• Assessing mental capacity where learning disability present_Aisha
• Cared-for person’s right to make decisions related to care_Sabrina
• Escalation of risk around self-neglect and pressure care_ZZ
• Faith-based advance decision related to health_Marie
• Hospital discharge concerns (for continuing health care)_Mr R
• Importance of advocacy in deciding medical aftercare_Rosemary 
• Making an end-of-life decision_Geraldine
• Mental capacity and self-neglect_George
• Multi-agency involvement and differing perception of mental capacity_Ms A
• SCIE case study_Importance of mental capacity advocacy_Ms C