Decisions can be small decisions such as what to wear, or big decisions such as where to live or whether to have medical treatment. Sometimes people can make some types of decision, but not others. Just because a person is not able to decide some things doesn’t mean they can’t decide anything.
Some people are more able to make decisions at certain times than other times. For example, a person might have good days and bad, and only be able to make bigger decisions on their good days. Just because a person is not able to decide all of the time doesn’t mean they can’t decide some of the time.
The MCA applies whenever a person is unable to make a decision because of a mental impairment; for example, a brain injury, dementia, learning disability or mental health condition. The impairment doesn’t have to be permanent and could be because of something temporary like a urine infection, or because they have been drinking alcohol or taking drugs. No one should assume that an impairment means a person can’t make a decision, without checking first.
When a person can’t make a decision because of a mental impairment, even with help, the MCA says they ‘lack capacity’ to make that decision.
How do we decide if someone lacks capacity?
If there is a good reason to think someone might not be able to make a decision, we will assess their capacity. Assessing capacity means we check carefully whether or not a person can make a decision, taking into account what the MCA tells us. For example, when a person is being discharged from hospital, a social worker might assess their capacity to decide where they should be cared for next. This could be in a care home, or in their own home, for instance.