you
the Mental Capacity Act has made a real
difference to social workers and their
practice particularly the kind of key
principles that are engendered in the
Act it's a very good piece of
legislation very visionary and it's
actually based on really sound social
work practice which is ensuring that the
person is at the heart of all the
decisions that are made with them or for
them that social workers really do use
their skills to engage and listen to and
understand what the needs and wishes of
that person are that they balance
ensuring that the person is able to make
the decisions and where the consequences
of decisions and therefore be able to
make what might be unwise decisions but
they have the capacity to do that
against where they need assistance with
those decisions that being made for them
but ensuring that those decisions
continue to be in their best interests
so the whole tenure of it really frames
in legislation what is really good
Social Work practice in person-centered
empowering work with people the Mental
Capacity Act will help to make sure
people get their rights as long as it's
done properly and with the person and
the support that they need to do that
you know because everybody has the right
to live their life to the full and reach
their full potential that may take a
little bit longer for someone with a
learning disability than it might do for
someone who doesn't have a learning
disability but we all learn differently
I think the mental heck capacity Act has
made a difference predominantly because
what it's done is provide a framework to
help think through often complex
clinical situations fundamentally what
the Act has done is shifted the emphasis
towards choice and an encouraging
autonomy and self-determination it
doesn't mean to say that we don't have
responsibilities for people who might be
seen as vulnerable and in some way at
risk but it clearly says the starting
point here is to encourage choice and to
respect people's autonomy but equally it
recognizes that there is a need to be
able to take this
on behalf of people who may because of
their learning disability or for many
other possible reasons can't make that
decision for themselves but you need to
do it in a way that is the least
restrictive as possible which still
ensures the fairest possible choice and
participation and that of course is
fundamentally done through the care
planning process and through the support
that people have my view is that anybody
who's involved in care planning needs to
consider the the five key principles in
the Mental Capacity Act that is firstly
that we're all deemed to have capacity
so we start from the premise that we can
all make decisions for ourselves that
we're all autonomous individuals and
have the right to be so and that there
needs to be some evidence to displace
that fact secondly and what I think is
really empowering about the Act is that
we're all entitled to make unwise
decisions and that just because we make
an unwise decision doesn't mean that
there should be a question about our
capacity thirdly is that each of us are
entitled to every support being given to
us to enable us to make our own
decisions so it's only after you've got
through those first three principles
that if you then come to the conclusion
that an individual hasn't got capacity
to make a specific decision that you
then move on to the fourth principle
which is about in those circumstances
you must make the decision in the best
interests of the individual concerned
and lastly is whatever option you come
up with must be the least restrictive on
the individual in order to make it and a
lasting care plan one that actually
achieves the right ambitions for people
it means to start it needs to start with
the person and what they want to do if
you don't start there you're forever
trying to play catch-up and actually
it's not resource efficient and it
certainly doesn't improve anybody's
quality of life what I would like a care
plan to do is to focus on the things
that the person can do
as much as possible if you're not
unconscious I think there are some
decisions that you are going to be able
to make they might be fairly simple
decisions but they can be very important
to the person themselves so it might be
do I have the capacity to decide what to
wear today out of a choice that's given
me do I have the capacity to think I
like to sit in the Sun or in the shade
or to eat ice cream or broccoli I mean
all kinds of things it's enabling the
person as much as you can so avoid the
idea of global incapacity because these
may seem like little decisions but they
can be very important to the person any
care planning must respect and respond
to the needs of the individual patient
and I think there is a danger in these
hurried and pressurised times that
pro-forma
responses are put in place good care
good care and treatment for adults
lacking capacity is personalized and
individualistic there's this idea that
people can't do this and can't do that
and there are blanket restrictions on
when you can go to your bedroom and
blanket restrictions on what time you
get up and go to bed these people in
their own home they should be able to
think you know what I fancy a bit of the
duvet morning but of course they're
often not allowed to and we would all
get a bit resentful I think and probably
harder to care for if if we're not
recognised as individuals I might like
to stop up late and watch something on
TV it would be immensely annoying to be
packed off to bed for staff convenience
at half past 6:00 or half past 7:00 or
in some cases that when here's off half
past five in any care plan prepared for
the Court of Protection details should
always be given in particular of why it
is that the arrangement set down in the
care plan or in our individuals best
interests especially when we're talking
about care plans prepared
the context of deprivation of Liberty
you must always be particularly clear
about why the arrangements are the least
restrictive option for the person
concerned the judge is always going to
be concerned to know that there's not
something else that could be done which
in some way impinges less on the
person's Liberty a really good example
of best practice is to have outlined in
the care plan why the options that are
not being pursued are not being pursued
and in the context of deprivation of
Liberty you need to say in terms and
explain in terms why it said that that
really is the least restrictive option
for the person concerned one would hope
that professionals seek to find as least
restrictive a care plan as possible for
any person that they're working with and
I think if they can honestly say they've
done that and taken all the steps
towards that and clearly if if a dolls a
deprivation of Liberty said God is
called for they must seek authorization
for that and we know of examples even
very recently of people who are held
unlawfully or removed unlawfully from
say their family circumstances and it's
something we have to guard against but
of course it's why the courts are there
too because at the end of the day the
Court of Protection will take a view on
this under the mental capacity act
capacity is seen as something that this
decision and also times specific and we
can we can imagine how it can be used to
support people's decision-making when it
comes to rather specific decisions like
choices around how to spend your money
for example or whether or not to accept
a particular treatment but I think it's
much broader than that I do think it is
about how do you support people in a way
that enables that have a full and active
life as independent as possible but at
the same time managing issues of risk
and protect and protecting people from
harm so it is really about bringing
those two aspects together and ensuring
people have an active life in which they
are free to do the things that they
enjoy and are safe
to do that I think what social workers
really like about the act but it puts
into a legislative framework really good
sound social work practice really
excellent person-centered approaches to
working with individuals and ensuring
that that particular person's needs and
feelings and wishes are weighed up in
terms of the decision-making about how
their care and support is delivered
another thing the Mental Capacity Act
does which i think is really important
is it says to people look it may well be
we understand that many of us as we age
may lose the ability at certain point to
make certain kinds of decisions one of
the things the Act does is it gives
people certain kinds of legal tools to
enable them to carry forward certain
kinds of decisions that are very very
important to them at a time in the
future when they may lose capacity none
of us know what's going to happen
tomorrow you know and maybe what needs
to happen is where the people are like
in a care home or residential home or
their own home maybe it should be that
it's all discussed in each person does
an advance decision so that you know
that everything's put in place for when
it if it does happen so you're seeing
this piece of legislation coming out of
some fundamental common law principles
that are about protecting and promoting
adult autonomy and carrying them forward
to the point where an adult male at
capacity it does something else as well
which is really important it focuses
when an adult is assessed as lacking the
capacity to make a certain kind of
decision
it focuses on promoting and protecting
their best interests that's all I think
this really is a very useful and
principled piece of legislation and I
think it's absolutely vital that all
health professionals who may be involved
in the care and treatment of adults
lacking capacity and that's a lot of
health professionals are familiar at
least with its basic printer
and and it's cool it's cool
legal tools and issues so I think a very
very important piece of legislation
you