The increasing demand for mental capacity assessments
Every case that goes to the court of protection requires a mental capacity assessment and the demand for quality assessments by the court is increasing. Indeed, the Court is now rejecting poorly conducted mental capacity assessments. In addition, Local Authorities may soon be barred from conducting assessment on cases that they have interest in, which will mean that Social Services will have to outsource the work.
So, who should carry out mental capacity assessments?
The diminishing role of GPs to undertake mental capacity assessments
In the past GPs have undertaken this function although the outcome of their assessments has sometimes been questionable. I have been shocked with some of the assessments I have seen, one example being the only statement made by the GP was, “Lacks capacity due to dementia” Just because a person has dementia, doesn’t necessarily mean they lack the capacity to make a specific decision. Furthermore, a mental disorder is not sufficient grounds alone to assess a person’s mental capacity, they need a full and thorough functional assessment as well as outlined in the second part of the two-stage test which constitutes a mental capacity assessment as set out in the Mental Capacity Act 2005.
We should not be surprised about this situation because of the generic nature of a GP’s role and the fact that most rarely see their own patients, as GP practices having moved to a “you can see any doctor” approach, due to unprecedented and increasing demand on their services. GP’s do not therefore have the detailed knowledge of individual patients their forebears had.
I chair the Patient Participation Group at my large GP practice and work closely with the GPs and other staff. We were proud to receive an ‘Outstanding” rating from the Care Quality Commission at our latest inspection. However, I am only too aware that GPs are finding work so demanding and stressful that none of them work full time any more. Undertaking mental capacity assessments on patients they rarely see, after having limited training on the Mental Capacity Act, is not a priority and while some doctors will complete them (with up to 10 weeks turnaround time) most GPs are now refusing to do them.
Training in mental capacity assessment report writing
In view of the increasing demand for our mental capacity assessment service and to provide evidence for our continuing professional development portfolios, senior consultants from Relative Matters recently attended training in London on completing mental capacity reports for the Court of Protection. Our aim being to ensure Relative Matters’ standards of assessment remain at a high standard and of consistent quality irrespective of who completes them.
The training was stimulating, informative and interesting. We gained expert information and advice on how to ensure our assessments are not challenged in court, which can delay the process and the ability to make decisions such as payment to a care home or home care provider.
Mental capacity assessments
The Mental Capacity Act specifies that every effort should be made to maximise a person’s capacity to understand. This takes skill and time and may involve things such as providing information in a more accessible format, talking slowly and repeating questions, using interpreters and ensuring the assessment is undertaken at a time when the person is at their best.
Mental capacity assessments take time to plan and obtain relevant information (it is vitally important to know about the person prior to the assessment) to gain rapport, explain things thoroughly, undertake the face to face assessment skilfully and write detailed and evidence-based reports.
The time taken to ensure the service Relative Matters offers is one of quality, that is person centred, prompt, efficient and thorough obviously comes at a price. This was recently challenged by someone wanting to know how they could explain our professional fee to a client when GPs charge so much less. The explanation went something like this;
“We are confident that the service Relative Matters offers is one of quality, that is person centred, prompt, efficient, thorough, unlikely to be challenged by the court and competitively priced. GPs are, at best, taking several weeks to provide a report that may be challenged, and increasingly refusing to undertake mental capacity assessments altogether”.
The choice is theirs.