The functional test within the 2 stage test of the Mental Capacity Act (2005) discusses the need to use or weigh information when making a decision. A useful starting point here is to explore what ‘use or weigh’ means in the context of decision making.
When we arrive at the point of using and weighing information many factors come in to play which influence the choices we make. Factors include; the degree to which we understand the information, our personalities, lifestyle choices, values, and our social circumstances to name but a few. Let’s take an example of a multi-million pound lottery win. Each of us would likely make different decisions with respect to the factors I have listed. Our choices to spend, save, go public, stay private will all be influenced by our understanding of the risks and benefits of each option. As well as our personal values, our lifestyle habits, our environment and our current financial circumstances.
Reflect on these factors and apply them to the following:
› Have a think about what you would do with multi-million pound win and why.
› Now have a think about a friend and what they might do and why.
› Now think about someone who’s opinion is important, they disagree with your choices. Will you change your mind on your decisions?
› Now have a think about a risky choice you may have made. On paper the risks outweighed the benefits.
› Was the decision informed by calculation?
› Was there an emotional driver attached?
This is a simple task which is useful in appreciating the differences that exist between us when making decisions and the variables we consider. When carrying out assessments of mental capacity these considerations can help. They help in exploring whether someone is making an unwise decision versus one which lacks capacity.
The ability to use and weigh information can be impacted on by cognitive impairments and thought disorders. In cases of traumatic brain injury where there could be frontal lobe impairment individuals can in structured conversations use and weigh information and arrive at an informed decision. However in real life contexts the process of using and weighing can be impacted on by such factors as inflexible thinking, reduced insight and disinhibition. I will be delving further into the realms of capacity and brain injury in a separate blog.
Expressive Communication Impairment
Where there is an expressive communication impairment (being unable to find the right words, having severely unintelligible speech, being non-verbal), the process of using and weighing information requires support from a skilled person. Use of augmentative and alternative communication system can support an individual in expressing what is important to them through use of symbols and scales. It is essential that the system and symbols are familiar to the individual.
Therefore when assessing an individual’s ability to use and weigh many factors should be considered. It is really important to work with the individual and people who know them well to establish:
› How they usually make decisions. E.g. act alone, seek help, other opinions, act on impulse.
› Their values e.g. autonomy, independence, achievements, family, charity.
› Whether they take risks or lean towards safer decisions.
The information you gain can then inform the options you present the individual when supporting them to use and weigh information. The purpose of a mental capacity assessment is not just to conclude whether someone can or cannot make the decision for themselves. It is also a process of ascertaining their thoughts, beliefs and wishes surrounding the decision which can then inform a best interest decision if this is required.
TSF are experts in completing mental capacity assessments. Our simple referral form asks for details such as the above to ensure we have relevant information about the client. This assists us in completing the assessment.
Contact the team for more information on 0333 577 7020.