Mental Capacity

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 their own 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 two-part functional test within the Mental Capacity Act (2005) states that if the person concerned’s capacity is in doubt due to a change in mind or brain, then they are to be assessed whether they can sufficiently:

(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, and
(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, and are often poorly documented.

Publications

Gan JM, Riley J, Basting R, Demeyere N, Pendlebury ST. (2023). Decision-making capacity in older medical in-patients: frequency of assessment and rates of incapacity by decision-type and underlying brain/mind impairment. Age & Ageing. 2023

COMPASS project

Oxford COMPASS (COMPetency ASSessment) is a brief cognitive screening tool, designed to provide a cognitive profile with regards to a patient’s broad abilities in comprehension, memory and executive functioning. These cognitive constructs align with the core criteria for assessing mental capacity. Our long term aim is to investigate whether such a profile can help guide and inform Mental Capacity Assessments.

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, and are testing the tool in healthy and clinical populations.