Assessing Mental Capacity in Diagnosed Service Users

The purpose of this assignment is to discourse how a societal worker would measure the mental capacity of a service user who has been diagnosed with dementedness.

This essay will discourse the assorted significances of the different types of dementedness and how their mental wellness diagnosing affects an person ‘s ability to do of import determinations in their lives.

This essay will discourse how the Person-Centred Dementia Care ( VIPS ) model written by Tom Kitwood ( 1997 ) is able to steer the societal worker in using theoretical models and besides by using Law and measuring the specific capacity of a individual diagnosed with dementedness. This assignment will besides discourse how the citizenship, societal and medical theoretical accounts differentiate in their apprehensions and significances of dementedness. When measuring capacity it is of import to separate what type of capacity you are measuring. This could affect measuring determinations based on fiscal issues, lodging state of affairs, personal or domestic attention demands, the ability to measure hazard and safety, and besides sing their physical wellness attention demands.

The societal worker is able to use the Mental Capacity Act 2005 to supply justification and counsel when measuring the service user ‘s mental capacity. The societal worker will implement their professional opinion and answerability every bit good as work in a multidisciplinary mode and liaise with the GP, head-shrinker, brain doctor, community psychiatric nurse or community mental wellness squad. This would enable the societal worker to obtain more grounds and studies in finding the mental capacity of the service user.

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The societal worker will measure the mental capacity of a service user diagnosed with dementedness through any signifier of appraisal of demand i.e. safeguarding demands, support demands, lodging demands etc. It is besides of import to work in anti-discriminatory and anti-oppressive mode when working aboard service users.

The Alzheimer ‘s society ( 2010 ) found that diagnosable dementedness occurs in 5 % of those aged 65 old ages and over and in approximately a one-fourth of those aged 85 old ages. Of those with dementedness, 50-60 % will hold Alzheimer ‘s disease and a farther 10-15 % a vascular or multi-infarct dementedness. There are many signifiers of dementedness, which include potentially reversible unwellnesss, such as alcohol-related dementedness and those due to structural intracranial lesions. Dementia progresses as a really variable unwellness ; in the early phases patients with dementedness can go on to populate at place with the support of household and friends. As the unwellness progresses, this support needs to be supplemented with targeted aid to turn to facets of day-to-day life such as keeping nutrition, self-care and conformity with medicine.

Tom Kitwood ( 1997 ) was the first author to utilize the term ‘personhood ‘ in relation to people with dementedness. Kitwood ( 1997 ) defined ‘personhood as a standing position that is bestowed upon human existences, by others, in the context of relationship and societal being, it implies acknowledgment, regard and trust ‘ ( Kitwood, 1997:16 ) . The person-centred dementedness attention model ‘brings together thoughts and ways of working with the lived experience of people with dementedness that emphasised communicating and relationships. ‘ ( Kitwood 1997 cited Brooker 2007:14 ) .

The person-centred attention involves four major elements, the first being ‘valuing people with dementedness and those who care for them, advancing their citizenship rights and entitlements irrespective of age or cognitive damage ‘ Drake ( 1999:19 ) asserts ;

‘Citizenship is more than consumerism, which is where the look of power is limited to doing picks or showing penchants… it is about equality of chance and procedure although the result may be limited by the abilities of any person.

There are many ways of understanding dementedness which consist of the medical theoretical account, the societal attack and the citizenship attack to dementia The citizenship attack to dementia is a new attack which concentrates on how people with dementedness can assist society in footings of political, and societal rights, speaking portion in work, leisure, political arguments and spiritual jubilation. This attack is based on reciprocality, which is why this is a new development as cipher was believing about the people diagnosed with dementedness as being able to give every bit good as receive.

‘..dementia depict a group of symptoms which result from the devastation of encephalon cells. Although dementedness is a physical unwellness, most of the symptoms and jobs caused by the unwellness require psychiatric expertness and attention. ‘ ( Brotchie 2003 p. 2 )

Dementia affects people ‘s ability to retrieve things for more than a few seconds, make sense of the universe around them, header with day-to-day life undertakings and show their feelings. Other factors which affect people with dementedness are being able to believe clearly and work out jobs, make programs, unable header with an over-stimulating environment and happen it hard to act in a ‘normal ‘ manner.

Dementia is one of the chief conditions which are a consequence of mental confusion, memory loss, freak out, rational damage, or similar jobs. ( Mace et al 2006 ) . Brotchie ( 2003 ) found that different people may endure from different symptoms of dementedness, depending on their personality and their unwellness which lead to dementia. Brotchie ( 2003 ) outlines four most common symptoms of dementedness which are memory loss, alterations in personality, trouble in pass oning and loss of practical accomplishments. Memory loss is frequently a mark which occurs earlier and high spots something is non right, nevertheless could be mistaken for forgetfulness brought on my emphasis or feeling low in temper. A individual with dementedness may bit by bit bury where they are and how to acquire place ; hence underscoring there is a cognitive job. Peoples who may hold dementedness show alterations in their personality as people struggle to map with a limited thought capacity and over-react with mundane state of affairss and day-to-day undertakings. Peoples who are know to be unagitated may go aggressive or opprobrious, instead a individual know to be reserved before they became ailment may lose all societal suppressions.

‘Changes in people ‘s behavior are caused by harm to the encephalon and are non something the individual can command or forestall ‘ . ( Brotchie 2003 p.3 )

This position of harm to the encephalon as a cause of dementedness is supported by the medical theoretical account. The medical theoretical account dressed ores on encephalon harm and province at that place grounds by its nature of going worse as clip goes on. Jacques & A ; Jackson ( 2000 p.4 ) emphasise the sum of ; tibbs 2006 p16

‘..damage dementedness does to the lives of sick persons and those around them. It poses an tremendous challenge to wellness and societal services and to the community as a whole. ‘

Peoples diagnosed with dementedness may fight in doing themselves understood e.g. burying the name of simple objects or familiar people. They may besides happen it hard to do sense of what is being said to them as a consequence being unable to transport out instructions. Peoples with dementedness may bury things a few proceedingss after they have been told which is done by error and non knowing. Another symptom which may happen with a individual who has dementedness is holding serious jobs with transporting out simple undertakings such as binding a shoe lacing or making up a nothing, other undertakings such as feeding, dressing and rinsing go more hard as the unwellness becomes worse. The bulk signifiers of dementedness are irreversible, there are limited interventions but the most assist a individual can acquire is from their household to program for the best signifier of attention in the hereafter. It is critical for a physician at this phase to be involved in the individuals attention and intervention ( Brotchie 2003 ) . Cantley and Bowe ( 2004 ) found that there can be other causes for these symptoms which may non be linked to dementia such as a general medical unwellness, drug toxicity or a life altering event.

In the more advanced phases of the illness dependance additions and there is frequently the demand for residential or nursing attention. Issues of capacity and consent are of import at many phases of dementedness and peculiarly affect fiscal issues, ability to measure hazard and safety, and besides determinations over physical health care ( British Medical Association ( 2009 ) . Marshall & A ; Tibbs ( 2006 ) found that the Mental Capacity Act 2005, which followed the Adult with Incapacity Act 2000, means that we are more able to offer protection in jurisprudence to grownups who lack mental capacity, including people diagnosed with dementedness. A major alteration to this jurisprudence emphasised that ‘presumption against deficiency of capacity ‘ , which means a individual is now presumed to be capable of doing their ain determinations until proven otherwise.

The 2nd component from the person-centred model consists of ‘treating people as persons taking into consideration their alone personality, physical and mental wellness, societal and economic resources and that these will impact their response to neurological damage ‘ ( Brooker 2007:12 ) . Marshall & A ; Tibbs ( 2006 ) , have argued that this involves the presence or absence of Mental Capacity, which can be determined by two inquiries in order for the service user to hold the capacity to do the determination they should ‘be able to grok and retain the information which is stuff to the determination, particularly as to the effects of doing or non doing the determination in inquiry ‘ . It is of import for the societal worker to take this into consideration when measuring a individual capacity and doing a professional judgement. The service user should besides ‘be able to utilize the information and weigh it up as portion of the procedure of geting at a determination ‘ ( Marshall & A ; Tibbs 2006:34 ) . The societal worker should take into consideration that an person may retain capacity to do certain determinations such as, the pick of what to eat but, lack the capacity to do serious determinations such as pull offing their fundss i.e. paying measures.

Harmonizing to the British medical association ( 2009 ) all grownups are assumed to hold mental capacity unless there is grounds to turn out this is non the instance. There are many factors which can impact a individual ‘s capacity temporarily, such as desiccation, infection, medicine or weariness nevertheless premises about damage can non be based on age entirely or infirmity. It is of import for the assessor to speak with the individual when they are at their best taking in to consideration any physical jobs which could impact their cognitive ability.

‘A broad spectrum of ability is found in people deemed to hold impaired competency, including those populating with dementedness or with learning disablements. It is of import, hence, to see each individual as an person. Disease or other factors can ensue in impermanent, fluctuating or digesting incapacity. ‘ British Medical Association ( 2009:34 ) .

There are issues which need to be addressed before a individual is assessed to hold capacity or non such as, behavioral or cultural differences which are non indexs of impaired knowledge. On the other manus, determinations which come across as being ‘rash ‘ or ‘unconventional ‘ are non indictors of impaired knowledge either but can take to the procedure of a formal appraisal.

It can go clear by speaking to a individual with dementedness if they have sufficient mental capacity to do peculiar determinations ; nevertheless, if this is non clear a GP or head-shrinker are frequently the best professionals to give a position, particularly if the individual has had old contact with them. It is critical to understand in these fortunes an appraisal can non be rushed and clip should be taken in looking at the individual medical history and the determination for which the individual is being assessed. An persons ‘ visual aspect and behavior demands to be taken into history e.g. if they suffer from a temper upset or a mental unwellness. If a individual has suffered from harm to the encephalon, such as a shot, this can do verbal communicating near impossible nevertheless it is non needfully an index of decreased mental capacity. Similarly, long term memory loss is non an index of decreased mental capacity nevertheless being unable to retain information long plenty to do a determination would annul it. British Medical Association ( 2009 ) .

If a individual has to do a serious determination and there is still doubt about their mental capacity it would be advised for a formal appraisal to be completed. If a individual lacks capacity it is normally possible to measure their ability through conversation, but if they refuse assessment, it can non continue unless required by tribunal. If it is clear a individual lacks mental capacity and they have n’t given their consent determinations on their behalf are governed by the Mental Capacity Act 2005.

Harmonizing to Brown & A ; Barber ( 2008 ) , the Mental Capacity Act 2005 begins, in Section 1, by underscoring five cardinal rules to be followed whenever working within this model of the Act. These are to work with the individual with dementedness with the premise that they have capacity unless it is proven otherwise, non to handle the individual as unable to do determination unless all the stairss to assist them to make so hold been unsuccessful. The 3rd rule of the Mental Capacity Act 2005 emphasises non to handle a individual as ‘unable ‘ to do determinations for themselves merely because the individual may do an unwise determination and a determination made, under this Act, on the behalf of a individual who lacks capacity must be done, or made, their ‘best involvement ‘ . The concluding key rule of the Act is:

‘Before the act is done, or the determination is made, see must be had to whether the intent for which it is needed can be as efficaciously achieved in a manner that is less restrictive of the individual ‘s rights and freedom of action ‘ Brown & A ; Barber ( 2008:5-6 ) .

The 3rd component of the person-centred attack is ‘looking at the universe from the position of the individual with dementedness, recognizing that each individual ‘s experience has its ain psychological cogency, that people with dementia act from this position and that empathy with this position has its ain curative potency ‘ ( Brooker 2007:63 ) . The assessment procedure will dwell of many countries that should see their environment, such as their place and fundss ‘many persons with early dementedness retain the capacity to finish an digesting power of lawyer which at a ulterior day of the month can be registered ‘ ( Brooker 2007:67 ) . The Mental Capacity Act 2005 includes the ‘Lasting Powers of Attorney ‘ ( subdivision 9-12 and 22-23 ) . A Lasting Power of Attorney in subdivision 9 ( 1 ) as:

• ‘a power of lawyer under which the giver ( ‘P ‘ ) confers on the done ( or beneficiaries ) authorization to do determinations about all or any of the following-
• P ‘s personal public assistance or specified affairs refering P ‘s personal public assistance, and
• P ‘s belongings and personal businesss or specified affairs refering P ‘s belongings and personal businesss, and which includes authorization to do such determinations in fortunes where P no longer has capacity. ‘ ( Brown & A ; Barber 2008:41 ) .

The societal worker will besides measure safety and hazard. Marshall & A ; Tibbs ( 2008:44 ) argue ‘as dementedness progresses the hazard of ego disregard, development and roving may find a individual ‘s ability to populate entirely, while hazards posed to other from driving and abuse of gas contraptions may do great concern still ‘ . In this state of affairs the degree of this would be excessively high for that individual to go on to populate within their place environment due to wellness and safety grounds. This may ensue in the usage of the Mental Health Act 1983 for the intent of lasting residential adjustment or 24 hr attention by household members or carers.

The Mental Capacity Act 2005, Section 2 refers to the ‘diagnostic trial ‘ which is narrowed down to the ‘functional trial ‘ in order to place the smallest country of decision-making to use for the incapacity trial. Further in the Act, Section 3 provides the trial which should be used to find a individual ‘s mental capacity on a peculiar determination e.g. refusal of medicine. The Section 3 trial is to set up whether a individual is able to understand information relevant to the determination and if they are able to retain to information. The individual is besides tested of their abilities to utilize or burden that information as portion of the procedure of doing the determination or if they can pass on efficaciously sing the determination ( by speaking, utilizing gestural linguistic communication, or any other manner ) Brown & A ; Barber ( 2008 ) .

Harmonizing to the Mental Capacity Act 2005, anyone involved in the attention or support of a individual could hold a say in the capacity appraisal, which would normally include, household members, wellness and societal attention workers, but most significantly physicians, head-shrinker and psychologists appraisals would be important. Typically the people who are responsible to transport out capacity appraisals are nurse practicians, societal workers, physicians and neuropsychologists ( Halton Council 2008 ) .

There five cardinal rules of the mental capacity act 2005 have to be considered if a professional is to make an appraisal with a individual diagnosed with dementedness. It is of import that the societal worker begins with the premise that the individual has capacity. It is besides of import for the societal worker to understand a individual ‘s visual aspect or diagnosing is non a mark of a deficiency of capacity, hence foregrounding the demand to document accurate information for sing that a individual may non hold capacity in relation to a specific determination. The societal worker has to see mental capacity issues throughout the appraisal as they would put on the line and safeguarding issues, observing the particular countries which raise concern. The Mental Capacity Act 2005, Code of Practice provinces:

‘Where appraisals of capacity relate to daily determinations and caring actions,

no formal appraisal processs or recorded certification will be required ‘ .

( Davies 2008:8 )

The Mental Capacity Act 2005, Code of Practice, gives counsel on when there is a demand for a clearly documented appraisal. This is where a determination which needs to be made has major effects, such as a determination to alter adjustment or a determination to accept or worsen support at place. Another ground for a clearly documented appraisal may be if there is a ‘dispute with the individual, their household or the attention squad, as to the capacity of the person ‘ . The individual who may necessitate the appraisal may be capable to dispute hence necessitating an appraisal for capacity or ‘there may be legal effects of happening capacity ‘ . ( Davies 2008:9 ) One chief ground for a individual to hold an appraisal for capacity is to cut down the hazard the individual poses to themselves in footings of preventable agony or harm ( Davies 2008 ) . Not all of these fortunes are exact and require professional opinion and on-going supervising. Davies ( 2008 ) explains in some fortunes the capacity for an person may be related to a specific determination at a specific point in clip therefore, the demand for an ongoing appraisal for capacity may be required.

Brown and Barber ( 2008 ) discourse the construct ‘best involvements ‘ in respects to the Mental Capacity Act 2005. The Act 2005 states that one important rule is that if a determination is made for or, on the behalf of person else who lacks capacity must be done, or made in that individual ‘s ‘best involvement ‘ . This rule applies to anyone who is transporting out the duty for doing the determination such as a household member, paid worker or carer, an lawyer, a court-appointed deputy or wellness professionals. Brown and Barber ( 2008 ) assert the demand for people who have the duty for doing other peoples determinations, being familiar with the Act ‘s new demands for the checklist attack. The Mental Capacity Act 2005 new checklist attack is set out to incorporate common factors which should be measured on every juncture a determination is to be made. The Law Commission ( 1995, para 3.28 )

‘First, a checklist must non unduly burden any decision-maker or promote unneeded intercession ; secondly it must non be applied excessively stiffly and should go forth room for all considerations relevant to the peculiar instance ; thirdly, it should be confined to major points, so that it can accommodate to altering positions and attitudes. ‘

A individual who has the duty to do determinations on the behalf of person who ‘lacks capacity ‘ should see the undermentioned stairss to guarantee the best involvement of that individual. These stairss are to foremost promote engagement, which is for the individual doing the determination to make their uttermost to promote and back up the individual with dementedness to take portion in doing the determination, secondly place all relevant fortunes, this is to seek include all the things the individual who lacks capacity would normally take into consideration if they were doing the determination themselves. Third, happen out the individual ‘s positions who ‘lacks capacity ‘ such as their yesteryear, present wants and feelings, any beliefs and values, and any other factors which the individual would normally see. An of import factor is to avoid favoritism and non do statements about a individual best involvement because of their age, visual aspect or diagnosing. It is necessary to see whether the individual might recover capacity, if so can the determination delay until so? Finally, the individual doing the determination should see if the determination concerns vital intervention, and should non do premises about how the individual should or should n’t populate ( Falconer 2007 ) . The Mental Capacity Act 2005 besides include confer withing others an a cardinal facet of sing how a individual ‘best involvement ‘ could be meet efficaciously. If it is appropriate to make so, discuss with other people for their sentiments about the individuals best involvement, as they may hold information about the individual wants and feelings. The Mental Capacity Act 2005 province the people that should be consulted are:

‘anyone antecedently named by the individual as person to be consulted on either the determination in inquiry or no similar issues, anyone engaged in caring for the individual, near comparative, friends or others who take an involvement in the individual ‘s public assistance, any lawyer, and any deputy appointed by the Court of Protection to do determinations for the individual ‘ .

( Brown and Barber 2008:34 )

If the determination is for an of import medical intervention and there is no 1 to confabulate with so an Independent Mental Capacity Advocate ( IMCA ) must be consulted. In safeguarding concerns if a individual is deemed to hold no capacity affecting a specific type of hazard and determinations, and household members are deemed inappropriate, it is indispensable that a IMCA is involved in of import safeguarding probes in supplying best involvement determinations for the person.

The Independent Mental Capacity ( IMCA ) Service was a late enterprise to the Mental Capacity Act 2005, and has been available since October 2007. Section 35 of the Mental Capacity Act 2005 highlights the chief intent of IMCA, which is to back up and stand for the individual concerned, to set up their wants and feelings and to supervise that the Acts rules and the checklist are being met.

The Mental Capacity Act 2005, high spots that a decision-maker does more than doing a determination on person behalf who lacks capacity, but besides ensures the individuals human rights are met. The Mental Health Act 1983 has a procedure whereby they are able to confine people who are mentally broken which in specific fortunes would be an appropriate response, nevertheless the Mental Capacity Act 2005 have a different attack seeing restraint as ‘deprivation of autonomy ‘ . When a individual is said to ‘lack capacity ‘ it is hard for them to make up one’s mind about being in a peculiar topographic point and is in consequence deprived of their autonomy, and there are several options which could be taken:

• ‘scale down the degree of limitations to what would be seen as a limitation of motion instead than a want of autonomy ‘
• ‘arrange an appraisal under the Mental Health Act with a position to utilizing its powers ‘
• ‘make an application to the Court of Protection to do a personal public assistance determinations ‘
• ‘follow the new ‘Bournewood ‘ process
• ‘consider short-run or exigency usage of common jurisprudence powers ‘ .

( Brown & A ; Barber 2008 p.39 )

The ‘Bournewood Judgement ‘ involved an NHS trust to take an autistic adult male unable to talk and limited apprehension from a twenty-four hours Centre to an in-patient unit without his consent. In ‘2004, the European Court of Human Rights upheld the households view that detainment under the Common Law of an incapable patient utilizing the best involvement statement was improper because it was excessively arbitrary ‘ ( Marshall & A ; Tibbs 2006:43 ) . If people are to be deprived of their autonomy, there must be some lawful justification and some precautions. ‘For patients with mental unwellness, usage of mental wellness statute law should be considered if the patients run into the statutory demands. The ‘Bournwood Judgment ‘ marked a important measure forwards in the acknowledgment of the rights of unqualified persons ‘ ( British Medical Association 2009:87 ) . It besides enforced to the authorization and rights of older people with impaired capacity.

The 4th component of person-centred attention ‘is turn outing a supportive societal environment, recognizing that all human life is grounded in relationships and that people with dementedness need an enriched societal environment which both compensates for their damage and Fosters chances for personal growing ‘ ( Brooker 2007:83 ) . This is position of sing the societal environment of a individual with dementedness is supported by the societal theoretical account as it is based upon a individual environment and societal circumstance, sing dementedness as an ‘impairment ‘ which consequences in a individual going unable to work as a ‘normal ‘ individual. This is a positive mentality on dementedness as it can follow a rehabilitation attack leting opportunity for alteration and doing the experience of dementedness a better one, whereas, on the other manus the medical theoretical account which argues otherwise which is frequently a pessimistic position. Marshall & A ; Tibbs ( 2006 ) book expands the constructs of rehabilitation to include teamwork, working with households, prosthetic devices, taking causes of extra disablement, larning motive and concentrating on what the chief job is which needs to be addressed.

Whilst working with older people societal workers must retrieve to work in an anti-discriminatory and anti-oppressive mode at all phases, such as, an appraisal, planning and intercession. The person-centred model enables a societal worker who works aboard people diagnosed with dementedness to understand at that place medical conditions and to supply a bundle of attention at a deeper degree and to supply them with many chances in taking a valued and carry throughing life.

These criterions are underpinned by values and moralss that must back up the development and bringing of pattern. These include a societal worker showing regard for an single, keeping trust and keeping confidentiality. Other values consist of apprehension and doing usage of schemes to dispute favoritism, disadvantage and other signifiers of inequality and unfairness ( Crawford & A ; Walker 2009 ) . Butler & A ; Lewis ( 1973 p.30 ) argue:

‘Ageism can be seen as a procedure of systematic stereotyping of and favoritism against people because they are old, merely as racism and sexism accomplish this for skin coloring material and gender ‘ .

Crawford & A ; Walker ( 2009 ) argue that ‘working with in older people may include people who are vulnerable, who may be oppressed and disadvantaged nevertheless, each individual is single and have their procedure of acquiring older ‘ ( Crawford & A ; Walker, 2009:34 ) therefore it is of import to handle each individual separately. Whilst working with older people it is indispensable to see a whole scope of issues such as showing consciousness of the legal, policy, and political context of the work being completed, combined with an in-depth apprehension of the experiences of that older individual in their specific state of affairs. The societal worker must be attentive to potentially opprobrious state of affairss, whilst at the same clip working in a multidisciplinary mode with other relevant professionals and administrations. Social workers must work towards developing a holistic attack to help their pattern in working with older people as it allows them to take into history the individuals state of affairs in society and the values and moralss of societal work.

Overall the chief rule to measure a individual diagnosed with dementedness is to retrieve to presume the individual has capacity if proved otherwise. Once an appraisal is completed and the appropriate professionals are consulted and it is deemed that the individual is deemed to miss capacity so it is critical to work towards the individual best involvement guaranting them of their human rights. This is done by utilizing the checklist attack guaranting all the factors are covered before a determination is made. The individual who has the duty for make the determination on person behalf could be a professional, household relation, Power of Attorney or an Independent Mental Capacity Advocate. All these issues must be considered whilst working with person who lacks capacity. It is important when measuring and finding a individual ‘s mental capacity to take into consideration all facets of the individual ‘s life, wellness and of import determinations that require to be made. It is besides indispensable that the societal worker has to take into consideration that a mental capacity is based on a specific facet of a individuals capacity for illustration managing fundss, lodging etc.