Part 5 - Communication & Mental Capacity

The final component of this series will address is that of ‘communicating a decision’. Within the assessment of mental capacity, the client is required to communicate their decision. All practical steps should be taken to support this decision making. Decisions can be communicated verbally and non-verbally. Non-verbal communication can include signing, eye gaze, gestures, use of symbols and writing as well as encompassing an individual’s behaviours. Here we are concerned with how an individual expresses themselves.

Communication Impairments

Communication impairments can mask capacity in that assumptions are made in relation to an individual’s understanding and cognitive abilities based on the nature of their expressive abilities.

These impairments can be:

• Congenital, for example a motor speech disorder secondary to cerebral palsy
• Developmental, for example children who have autism may be non-verbal
• Acquired, for example sudden onset of aphasia secondary to a stroke, or a gradual deterioration in speech secondary to motor neurone disease.

What other difficulties can arise with communication impairment?

With each of the above there can be accompanying difficulties with comprehension, but not always.

There are cases where individuals may be unable to communicate at all, secondary to being in a coma. Some individuals may be in a ‘locked in’ condition. Locked in syndrome is a condition in which a person is aware but has complete paralysis of nearly all voluntary muscles in the body except for vertical eye movements and blinking. Therefore they are unable to verbally communicate and have limited non-verbal means of communication. Assessing mental capacity with people with such a condition requires a high level of knowledge and skills. The individual needs to also satisfy the domains of ‘understand’, ‘retain’ and ‘use and weigh’.

How to aid communication needs

If your relative or client has a communication impairment and is in the position where a mental capacity assessment is being undertaken ensure that their communication needs are identified and therefore the appropriate support is put in place. This could mean provision of:

• Interpreters
• Sign language interpreters
• Ensuring that the relevant language and terminology is installed on their communication device to enable optimal engagement in the discussion.
• A speech and language therapist to support communication needs
• Visual aids and symbols tailored to the communication needs of the person.

Advice can be sought from an appropriate professional, such as a speech and language therapist. Speech therapists can assist in assessing the person’s communication abilities and that the means used to facilitate expression are in keeping with their communication needs and support optimal engagement in the decision making process.

TSF are able to provide speech and language therapists for mental capacity assessments. All of our assessors take time to prepare prior to an assessment, creating specific tools to aid communication during the assessment.

For more information about booking a mental capacity assessment contact the team on 0333 577 7020.

Take a look at our other blogs including the rest of this series from our Speech and Language therapist Jo Holder.