Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To assess a patient's mental capacity in a primary care setting, use the following specific criteria based on the Mental Capacity Act 2005 and UK guidelines:
- Assume capacity initially: A person must be assumed to have capacity unless it is established otherwise on the balance of probabilities NICE NG108.
- Decision-specific assessment: Capacity must be assessed in relation to the particular decision at the time it needs to be made NICE NG108.
- Identify impairment or disturbance: Confirm that any inability to make the decision is due to an impairment or disturbance in the functioning of the mind or brain NICE NG108.
- Assess understanding: Determine if the person can understand the information relevant to the decision, including the salient factors and options available NICE NG108.
- Assess retention: Check if the person can retain that information long enough to make the decision NICE NG108.
- Assess weighing up: Evaluate whether the person can use or weigh that information as part of the decision-making process NICE NG108.
- Assess communication: Confirm the person can communicate their decision by any means, including verbal, non-verbal, or other forms NICE NG108.
- Support and reasonable adjustments: Ensure all practicable steps have been taken to support the person’s decision-making, such as using communication aids, involving trusted individuals, or adjusting timing and environment NICE NG108.
- Do not judge based on perceived wisdom: Do not assume lack of capacity because the decision seems unwise or risky NICE NG108.
- Use a collaborative, person-centred approach: Conduct the assessment respectfully, non-judgmentally, and in a way that preserves dignity, involving others as appropriate NICE NG108.
These criteria should be applied proportionately to the complexity and significance of the decision, and the assessment should be documented clearly NICE NG108.