/ Topics / By

Mental Capacity: Making Decisions and Planning Ahead

Mental Capacity Making Decisions and Planning Ahead​

Mental capacity is the ability to make decisions for yourself. From simple daily choices like what to wear, to life-changing decisions about finances or medical treatment, having capacity means you can understand information and use it to make a choice.

 

However, illness, injury, or disability can sometimes affect a person’s ability to do this. Understanding how mental capacity works, how it is assessed, and how to plan for the future is vital for protecting your rights and the rights of your loved ones.

What is Mental Capacity?

A person is considered to have mental capacity if they can do the following four things when faced with a decision:

  1. Understand the information relevant to the decision.

  2. Retain that information long enough to make the choice.

  3. Weigh up the information (pros and cons) as part of the decision-making process.

  4. Communicate their decision (whether by talking, sign language, or other means).

Capacity is “time and decision-specific.” This means a person might lack the capacity to manage their finances but still have the capacity to decide what to eat for lunch.

Causes of Reduced Capacity

A lack of capacity can be temporary or permanent. Common causes include:

  • Dementia: As the condition progresses, decision-making often becomes harder.

  • Brain Injury or Stroke: Sudden trauma can impair cognitive function.

  • Mental Health Conditions: Severe episodes of illness (like psychosis or severe depression) can temporarily affect capacity.

  • Learning Disabilities: May affect the ability to understand complex concepts.

  • Substance Misuse: Drugs or alcohol can cause temporary incapacity.

The Mental Capacity Act (UK)

In England and Wales, the Mental Capacity Act 2005 provides a legal framework to protect people who cannot make decisions for themselves. It is built on five key principles:

  1. Presumption of Capacity: Always assume a person can make a decision unless proven otherwise.

  2. Support: Every effort must be made to help the person make the decision themselves before concluding they cannot.

  3. Unwise Decisions: A person is allowed to make an unwise or eccentric decision; this does not mean they lack capacity.

  4. Best Interests: Any decision made on behalf of someone who lacks capacity must be in their best interests.

  5. Least Restrictive: Any action taken must be the least restrictive option for the person’s basic rights and freedoms.

Note: In Scotland, this is covered by the Adults with Incapacity (Scotland) Act 2000. Other countries like the US and Canada have their own specific laws regarding competency and guardianship.

Planning for the Future

Loss of capacity can happen unexpectedly. Planning ahead ensures your wishes are respected even if you cannot express them later.

1. Lasting Power of Attorney (LPA)

An LPA is a legal document that lets you appoint one or more people (attorneys) to help you make decisions or to make decisions on your behalf.

  • Property and Financial Affairs LPA: Covers bills, bank accounts, and selling property.

  • Health and Welfare LPA: Covers daily routine, medical care, and life-sustaining treatment.

2. Advance Decisions (Living Will)

An advance decision allows you to legally refuse specific medical treatments in the future. This is legally binding in England and Wales, provided it meets specific criteria.

3. Advance Statements

This is a written statement of your preferences, wishes, beliefs, and values. While not legally binding, it helps families and doctors understand what you would have wanted when making “best interest” decisions.

Global Support and Resources