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

catherine.dooley@swlstg-tr.nhs.uk

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 (nigatt@bps.org.uk)

Look at material on BPS and PSIGE websites