Week 7 - Mental capacity and covert administration of medication

Question 1

What is mental capacity

Answer 1

Having the power and ability to make your own decisions

NOTE:
- if someone lacks capacity any decsion made for them should be done in their best interest
- i.e. consider aptients: beliefs, past and present wishes / feelings / statements

Question 2

How is mental capacity assessed

Mental Capacity Act 2005

Answer 2

Everyone is assumed to have capacity unless when assessed they are then considered to lack it
- dont judge based on age, disability, diagnosis, health etc.
- dont assume they still dont have capcity because they lacked capacity in the past

USE: Mental Capacity Act 2005
- Lack Capacity if they’re unable to make / communicate a decision at a particular time due to impairment or disturbance in brain
- if patient refuses to have assessment need to go to court of protection

LACK if dont meet one of the following:
1. can’t understand the info related to the decision that needs to be made
2. can’t remember info long enough to make a decision
3. cant communicate the decision
4. cant use the info as part of decision making process

DoLS (Deprivation of Liberty Safeguards)
- used for patients in hospitals / care homes if they are deprived of the liberites
- DoLS checks decisions are necessary + in patients best interest
- Need to apply for DoLS and they last a year, then re-apply

Question 3

What are the 5 key principles

From Mental Capacity Act 2005

Answer 3

1. must assume they have capacity to make a particular decision unless established otherwise
2. person must not be assumed to be unable to make decision unless all practical steps have been taken to help them make the decision
3. person must not be treated as unable to make a decision because they make an unwise decision
4. Any act / decision made on behalf of someone who lacks mental capacity must be done in their best interests
5. Before any act / decision is made, consider if the purpose it is needed for can be achieved in another way which is less restrictive on the persons rights and freedoms

Question 4

Under what circumstances may mental capacity be impaired

Answer 4

When there is an brain impairment or disturbances

If under Mental Health Act (MHA) but have capacity treat under MHA
If under MHA but lack capacity treat under MCA

NOTE:
- capacity can fluctuate over time
- some can lack capacity temporarily or permanently

Question 5

Describe the key principles guiding care of patients who may lack mental capacity

i.e. decision making for future

Answer 5

1. Advance Care Planning
   - talks between pt and HCP about future decisions if mental capacity is affected
   - ensure pts beliefs, goals are taken itno acount
   - plan is recorded / documented and regularly reviewed
2. Independant Mental Capacity Advocates (IMCA)
   - provide safeguard to pts lacking family support
3. Lasting Power of Attorney
   - pt nominates a trusted person to make decisions for them if lack capacity in future
   - nominee must be registered with public guardian
4. Advance Decisions
   - enables pt to refuse SPECIFIED medical treatment in future if they lack capacity to refuse
   - ONLY used to REFUSE treatment not demand it
   - can be over-ridden (if theres evidence)
5. Advance Statements
   - used for GENERAL decisions

Question 6

What is covert adminstration

Answer 6

Hidden adminstration of medicine to patient (without their knowledge)

Question 7

Under what circumstances may covert adminstration be used

Answer 7

LAST RESORT

• Only used when pt refuses medication AND doesnt have mental capacity to understand the decision
• Medicines used covertly must be essential for health + well being
• Must be admisntered in least restrictive way

NOTE:
- severe consequences for wrong covert adminstartion
- e.g. no care plan, no consent or authorisation