18/10/20151 mental capacity act 2005 (coming into effect april 2007 in england) bps development work...
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Mental Capacity Act 2005Mental Capacity Act 2005(coming into effect April 2007 (coming into effect April 2007 in England)in England)BPS development workBPS development work
Catherine Dooley
December 11th 2006
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BPS workBPS work
Guidance for Applied Psychologists Production of a leaflet joint with R.C.P. Series of articles in Forum Establishing regional groups to
support/train other – joint with R.C. P. and linked to Care Standards Improvement Agency in England
Future event on theoretical aspects
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Scope of capacity issuesScope of capacity issues
750,000 people with dementia in the UK Canadian evidence – 80% of capacity issues for people
over 50 NHS and social services - GPs
Also Learning Disability and Neuropsychological impairment
Bournewood Judgement will come under Capacity Act
Some MHA issues will come under Capacity Act
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Assessment of Capacity - The Assessment of Capacity - The Competent IndividualCompetent Individual understands in simple language what the
treatment is, its purpose and nature and why it is being proposed
understands its principal benefits, risk and alternatives
understands in broad terms what will be the consequences of not receiving the proposed treatment
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Assessment of Capacity - The Assessment of Capacity - The Competent IndividualCompetent Individualretains the information for long
enough to make an effective decisionmakes a free choice and free from
pressure
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Membership of the BPS PPB Membership of the BPS PPB GroupGroupLearning disability ForensicNeuropsychologyOlder peopleAdultInviting more subsystems
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Interim Guidance 2006 - areasInterim Guidance 2006 - areas
Health CareLegalFinanceResearch
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Health CareHealth Care
Where to liveConsent to treatmentAdvanced Directives
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LegalLegal
Capacity to stand trialWitness in courtConsent to sexual relationsInstructing a solicitor
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FinanceFinance
Management of financial affairsEnduring Power of AttorneyMaking a Will
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Status of recommendationsStatus of recommendations
Status of evidence - IV in NICE categories: - ‘evidence from expert committee reports or opinions and/or clinical experience of respected authorities’
Examples of current practice
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Neuro-psychologyNeuro-psychology
General intellectual abilityMemory and learningAttention and ConcentrationVerbal comprehensionReasoningInformation processingExecutive functioning
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Mental Health AspectsMental Health Aspects
selective attentioncausal attributions cognitive biasessocial cognitionself perceptiontheory of mind deficitsmood
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Other Psychology ModelsOther Psychology Models
Readiness for Change
Health Psychology, e.g.Health Belief model Theory of Reasoned Action
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Readiness For ChangeReadiness For Change
Pre-contemplation (I will never go into a home)
Contemplation (I might but not yet)Planning (I think that I should….)Action (Let’s start to work on it)
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Health Psychology ModelsHealth Psychology Models
Underlying rationalityRole of beliefs and intentionsFaulty weighting of factors
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Personal/cultural HistoryPersonal/cultural History
premorbid personality and coping style
family situation and historycultural factors
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Social RelationshipsSocial Relationships
suggestibilitysocial desirabilityfaking good/ faking bad
deference/ acquiescencesocial competence and
assertiveness
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Example – Financial problemsExample – Financial problems
General IQ below average Arithmetic and problem solving ?LD/specific problems Repeated problems with debt
Suggestibility and social compliance
Resolved with advocacy service
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Example – Financial abuseExample – Financial abuse
Referred as ?dementia Severe Dyslexia Early neglect and abuse Low self esteem and assertiveness Unstable diabetes – specific effects on
attention and memory Normally managed finances well
Son took EPA
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Status of expected Status of expected competencycompetencyNot normally at level of court reportProfessional judgement based on the
best available informationMost assessment measures have
poor psychometric properties
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Status of competency Status of competency Silberfeld and Silberfeld and
Checkland 1999Checkland 1999
‘The inferential gap’…lack of direct inference (except in cases that are unlikely to be disputed) from evidence to decision…...
uses a form of expert knowledge on causal influences and patterns
purpose is to explain in a way that makes actions rational
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Pepper-Smith, Harvey and Pepper-Smith, Harvey and Silberfeld (1996)Silberfeld (1996)……propose that at least four
different frameworks could be used in the evaluation of capacity – psychiatric, cognitive, functional and decision-making, all of which remain, they say, more or less unrelated.
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The need for a model for The need for a model for formulation of capacityformulation of capacityA tentative framework for
conceptualisation of capacityMay be more than one model –
different areas, different issuesNeed to incorporate research and
models from other areas of academic psychology
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DECISION MAKING STRUCTURES AND
PROCESSES
OPTION APPRAISAL OF ALTERNATIVES
AFFECTED BY HEURISTICS
WEIGHTING OF RISK
PRIMING ETC
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AFFECTED BY COGNITIVE AND NEUROPSYCHOLOGICAL
FACTORS
DECISION MAKING STRUCTURES AND
PROCESSES
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PSYCHOSOCIAL FACTORS
DIRECTLY, OR INDIRECTLY DISTORTING DECISIONAL PROCESSES
COGNITIVE AND NEUROPSYCHOLOGICAL
FACTORS
DECISION MAKING STRUCTURES AND
PROCESSES
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Further informationFurther information
Robert Kidd on national working group
Pat McKenna taking forward regional links
Contact Nigel Atter at the BPS to join e mail group ([email protected])
Look at material on BPS and PSIGE websites