Mental Capacity: What Does It Mean?

At Northern Healthcare we understand the importance of empowering those we support to maintain their independence and make informed decisions about their lives. A key aspect of our supported living service provision is equipping individuals with the skills and knowledge necessary to develop, strengthen, and maintain their mental capacity. By promoting understanding, we help the people we support navigate challenges with confidence and dignity.

But what exactly is mental capacity?

In this article, we’ll explore what the term means, the causes and consequences of its changes, and practical steps for planning the future, along with a mix of resources that might come in handy.

What Does Mental Capacity Mean?

Mental capacity refers to a person’s ability to make decisions at a particular time. It encompasses understanding, retaining, and weighing up information necessary to make a choice and then communicating that choice. Importantly, mental capacity is decision-specific; someone may have the capacity to make some decisions but not others.

For example, an individual may be able to decide what to eat for dinner but struggle with complex financial decisions. Capacity can also fluctuate over time, depending on factors such as health, medication, or stress levels.

In many legal systems, assessing mental capacity involves determining whether a person can:

Understand information relevant to a decision.
Retain that information long enough to make the decision.
Weigh the information as part of the decision-making process.
Communicate their decision by any means (e.g., speaking, writing, gestures).

Therefore, if someone lacks the capacity to make a specific decision, it may be necessary for others to act in their best interests.

According to the ‘Mental Capacity Act 2005, Deprivation of Liberty Safeguards’ published by the NHS, “there were an estimated 332,455 applications for DoLS received during 2023-24.” DoLS is a legal procedure designed to protect those who lack capacity –primarily in care homes or hospitals – where liberty is restricted by family members or guardians to keep them safe.

Referring back to the NHS’ findings “This is an increase of 11% similar to the previous year, which is closer to the rate of growth seen before COVID-19 (between 2014-15 and 2019-20 the average growth rate was 14% each year) following an interim period of relatively small increases in numbers of applications.” Though this safeguard ensures the person lacking capacity is protected and their needs are prioritised, it’s not an option to be taken lightly. There are also annual complaints of ongoing backlogs and delays in authorisations being completed, so it’s important to consider if restrictions and restraints are needed for the betterment of the person.

Causes and Consequences of Changes in Mental Capacity

Causes:

A variety of conditions and situations can affect your mental capacity:

Medical conditions such as dementia, Alzheimer’s disease, brain injuries, and neurological disorders.
Depression, anxiety, schizophrenia, bipolar disorder and other mental health issues.
Substance abuse, commonly alcohol or drug misuse. Remember that their impact on mental capacity can be temporary or permanent.
Certain medications may cause confusion or memory issues.
Developmental disabilities like autism or other intellectual disabilities.

Consequences:

A lack of mental capacity can have significant personal, legal and financial consequences. Without proper safeguards, individuals may:

Be at risk of financial exploitation or fraud.
Make decisions that negatively impact their mental health or safety.
Struggle to manage daily tasks or maintain independence.
Experience emotional distress if their needs and preferences are not considered or misunderstood.

For family and caregivers, a loved one’s loss of capacity can create challenges in ensuring their best interests are protected, all whilst navigating legal and medical systems.

Preparing for Potential Changes

Planning is a wise idea to safeguard someone at risk’s rights and well-being in the event of reduced capacity:

Create a power of attorney (POA): this is a trustworthy person appointed to make decisions on behalf of someone should they lose capacity. This can cover health and welfare decisions, finances, or both.
Write an advance directive or living will: this outlines preferences for medical treatment in situations where the person cannot make decisions themselves. It can include specifying treatments they want to avoid, such as resuscitation or life support.
Draft a will: different to a living will, this ensures that the individual’s wishes regarding their estate and belongings are carried out after their death. Like a POA, a will must be carried out while the person has the capacity.
Open a joint bank account: for financial management, having a trusted person as a co-signer on a bank account can simplify access to funds for bills and other expenses.
Communicate preferences clearly: documenting care, living arrangements, and other personal matters can help family members and caregivers act in line with the individual’s wishes.

Useful resources

Handling mental capacity issues can be difficult, but numerous organisations and resources can provide guidance and support:

Legal and Financial Help

Citizens Advice offers free, confidential advice on legal and financial matters.

Office of the Public Guardian (OPG) oversees the registration of POAs and protects those who lack capacity.

Local solicitors specialising in wills, trusts, and capacity-related legal issues.

Health and Social Care Services

General practitioners (GPs) can conduct medical assessments and refer individuals to specialists for capacity evaluations.

Adult social services offer support for daily living, care needs, and safeguarding.

Mental health charities like Mind or Alzheimer’s Society have resources for coping with mental health conditions that impact mental capacity.

Support Groups

Independent Mental Capacity Advocates (IMCAs) assist those who lack capacity and have no one else to support them.

Local advocacy services help individuals express their wishes and ensure their voices are heard.

Emergency Contacts

Police or social services safeguarding teams can intervene in cases of exploitation or abuse.

Helplines like Samaritans can offer immediate support and advice over the phone.

While the loss of mental capacity can be distressing, proactive planning and accessing the right resources can make a significant difference. By setting up legal protections, communicating preferences, and knowing where to turn for help, individuals and their families can navigate this complex issue with confidence and compassion.