Video-link assessments, Covid-19 and Principle 2 of the Mental Capacity Act

Danielle Roberts, Speech and Language Therapist

Author: Danielle Roberts, Qualified Speech and Language Therapist with specialism in acquired neurological disorders.

Mental Capacity Assessor and Quality Monitoring Officer at TSF Consultants

Throughout the Covid-19 pandemic and lockdown, TSF Consultants have continued to provide mental capacity assessments via live video-link. As a company, we feel that these remote assessments have been very successful and we support continuing to work in this way where indicated.

Part of the success of the video-link assessments is how they can facilitate adherence to Principle 2 of the Mental Capacity Act (MCA) (2005); supported decision-making. Principle 2 of the MCA (2005) states, ‘A person is not to be treated as unable to make a decision unless all practicable
steps to help him to do so have been taken without success.’ The crux of this principle is concerned with how individuals should be supported and given all practicable help during the mental capacity assessment process before declaring that they cannot make their own decision.

These remote video-link assessments offer a number of benefits for providing the practicable help referred to in Principle 2, whilst also protecting clients from the risk of Covid-19 transmission:

1. Time: Video-link assessments allow us to perform the assessment at the best time of day for a client and their communication. People with cognitive and communication impairments, in particular, typically have a best time of day in terms of their understanding and expression. The
remote assessments allow us to flexibly meet an individual’s needs regarding a best time of day, as we are no longer constrained by travel limitations and can easily perform assessments at a time to suit the client.

2. Location: The remote assessments facilitate us to put the client at ease through location. Once again, we are not constrained by travel limitations and assessor availability and can accommodate whatever location the client wishes for the assessment.

3. Avoidance of face masks: The live video-link assessments also allow us to avoid the use of masks. Masks are a necessary part of face-to-face assessments in our Covid-19 world. However, they can be constraining in terms of Principle 2 of the MCA (2005). Opaque masks obstruct the clarity and audibility of communication – they are used as a barrier to Covid-19, but unfortunately, they are also a barrier to communication.

Whilst ‘ClearMask’ is now being trialled by NHS staff and care workers, they are not suitable for all environments and the Royal College of Speech and Language Therapists report that there has been mixed feedback from Speech and Language Therapists who have tried using the mask.

4. Presentation of support material: The remote video-link assessments allow us to make use of screen sharing, which means that we can present a wide variety of materials to support the client’s comprehension and expression. Once we see the client’s communication function in practice, we can flexibly choose the best support materials from our desktop – this might be picture aids, written questions with highlighting of key words, or multiple-choice questions using written/image/symbol options. We were always able to take a selection of these materials to face-to-face assessments, but now we have a vast amount of support options at our fingertips during the assessment and all of these are used without the risk of shared touching of items and Covid-19 transmission.

5. Distancing: The remote assessments allow us to remain distanced whilst also being as close and loud as the client requires, to support the client’s vision and hearing. If we were to  to see the client face-to-face, social distancing would be necessary. However, when assessing clients remotely, the screen can be placed as close as is necessary to aid vision, and the volume can be set to the client’s preference.

At TSF, we will continue to promote the use of video-link assessments as they enable us to provide supported decision-making without placing any client at increased risk of Covid-19 transmission.

We acknowledge the updated Department of Health and Social Care MCA / DoLS guidance (updated 7th September 2020) and we support face-to-face assessments where they are indicated to meet a person’s particular circumstances and specific communication needs.