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Behind the cloak of competence: brain injury and mental capacity legislation

Sophie Moore (School of Psychology, University of Plymouth, Plymouth, UK)
Rebecca Wotus (School of Psychology, University of Plymouth, Plymouth, UK)
Alyson Norman (School of Psychology, University of Plymouth, Plymouth, UK)
Mark Holloway (Head First Assessment and Case Management Ltd, Cranbrook, UK)
Jackie Dean (N-Able Services, Birkenhead, UK)

The Journal of Adult Protection

ISSN: 1466-8203

Article publication date: 7 August 2019




Brain Injury Case Managers (BICMs) work closely with individuals with Acquired Brain Injury (ABI), assessing needs, structuring rehabilitation interventions and providing support, and have significant experience of clients with impairments to decision making. The purpose of this paper is to explore the application of the Mental Capacity Act (MCA) and its guidance when applied to ABI survivors. This research aimed to: first, highlight potential conflicts or tensions that application of the MCA might pose, and second, identify approaches to mitigate the problems of the MCA and capacity assessments with ABI survivors. It is hoped that this will support improvements in the services offered.


Using a mixed method approach, 93 BICMs responded to an online questionnaire about decision making following ABI. Of these, 12 BICMs agreed to take part in a follow-up semi-structured telephone interview.


The data revealed four main themes: disagreements with other professionals, hidden disabilities, vulnerability in the community and implementation of the MCA and capacity assessments.

Practical implications

The findings highlight the need for changes to the way mental capacity assessments are conducted and the need for training for professionals in the hidden effects of ABI.


Limited research exists on potential limitations of the application of the MCA for individuals with an ABI. This paper provides much needed research on the difficulties surrounding mental capacity and ABI.



Special thanks to the British Association of Brain Injury Case Managers (BABICM) for supporting this research study and enabling recruitment through their membership.


Moore, S., Wotus, R., Norman, A., Holloway, M. and Dean, J. (2019), "Behind the cloak of competence: brain injury and mental capacity legislation", The Journal of Adult Protection, Vol. 21 No. 4, pp. 201-218.



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Copyright © 2019, Emerald Publishing Limited

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