Assessment of mental capacity is a critical aspect of clinical practice, particularly for neurological patients. It provides the crucial judgement on patients’ ability to make informed decisions on a wide range of situations, from choosing treatment and discharge destination, to making financial decisions (e.g. selling a house), creating a power of attorney or making a will. Careful, well-informed capacity assessments are vital for ensuring the protection of peoples’ rights. In order to establish that a person lacks capacity, the law states that the person concerned must be unable to (i) understand information relevant to the decision, (ii) retain that information, (iii) use or weigh that information as part of the process of making the decision, or (iv) communicate the decision made.
In spite of clear legal guidance, mental capacity assessments are typically conducted in a short non-standardized interview and are highly variable in practice. They often fail to align with legal standards of the Mental Capacity Act, are solely based on a subjective, qualitative interview and are poorly documented.
We are therefore developing a standardised mental capacity assessment aligned neuropsychological screen, in line with legal standards, to improve the approach and documenting of this decision-making process, which has long-lasting and highly impactful consequences to patients’ rights to self-determination.
Currently, we have designed and developed a prototype tool with support from Medical Research Council Confidence in Concept funding (Demeyere, Duta, Jespersen). Validation of the tool with regards to the neuropsychological constructs is near completion.