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The purpose of this paper is to explore the consequences for older people’s mental wellbeing of understandings relating to the Mental Capacity Act 2005 (MCA). The MCA seeks to maximise people’s abilities to make decisions and provides a framework for decisions to be made in a person’s best interests should they lack the mental capacity to do so themselves (Graham and Cowley, 2015). Practice varies widely amongst health and social care practitioners and little is known about the nature of interventions under the MCA or the outcomes for service users’ lives and health, especially their mental health and emotional wellbeing.

By reflecting upon existing evidence this position paper offers a narrative of how practice in applying the principles of the MCA may impact upon the mental wellbeing of older people. Drawing upon court of protection judgements and existing research the author analyses the way the MCA is understood and applied and how institutional mechanisms might hinder good practice.

There are tensions between policy imperatives and examples of practice linked to the MCA, the spirit of the MCA and tenets of good practice. Despite efforts on promoting choice, control and rights there is growing paradoxical evidence that the MCA is used as a safeguarding tool with the consequences that it constrains older people’s rights and that it may encourage risk averse practice. The consequences of this for older people are considerable and include lack of choice, autonomy and self-determination. This discussion suggests that anxiety in relation to the application of the MCA stills exists in practice and that maximising older people’s capacity and supporting decision making is central in promoting mental health and wellbeing.

This position paper will identify how the MCA might be interpreted in action through consideration of existing evidence. This paper may lead to future research on how understandings of the MCA are constructed and what values underpin its application from conception to outcomes in relation to understandings of risk, risk aversion, decision making and the potential and need for emancipatory practice. Essentially, the paper will discuss how the MCA actually seeks to enhance the mental health and emotional wellbeing of older adults by offering a rather radical approach to understanding people’s wishes and feelings, but how attitudes may lead to misunderstandings and negative outcomes for the individual.

In a climate of serious case reviews identifying concerns and abuses in care it is imperative that understanding of the MCA inform good practice. However, what constitutes good practice requires unravelling and the agendas, requirements and attitudes of interventions need considering from an epistemological perspective as well as to project how the outcomes of decision-making impact upon the mental health of older adults. This paper will discursively add value to the narrative around how the MCA is applied in practice and how chosen practice often constructs the mental wellbeing of older adults.

The purpose of this paper is to create an automatic interpretation of the results of the method of multiple correspondence analysis (MCA) for categorical variables, so that the nonexpert user can immediately and safely interpret the results, which concern, as the authors know, the categories of variables that strongly interact and determine the trends of the subject under investigation.

This study is a novel theoretical approach to interpreting the results of the MCA method. The classical interpretation of MCA results is based on three indicators: the projection (F) of the category points of the variables in factorial axes, the point contribution to axis creation (CTR) and the correlation (COR) of a point with an axis. The synthetic use of the aforementioned indicators is arduous, particularly for nonexpert users, and frequently results in misinterpretations. The current study has achieved a synthesis of the aforementioned indicators, so that the interpretation of the results is based on a new indicator, as correspondingly on an index, the well-known method principal component analysis (PCA) for continuous variables is based.

Two (2) concepts were proposed in the new theoretical approach. The interpretative axis corresponding to the classical factorial axis and the interpretative plane corresponding to the factorial plane that as it will be seen offer clear and safe interpretative results in MCA.

It is obvious that in the development of the proposed automatic interpretation of the MCA results, the authors do not have in the interpretative axes the actual projections of the points as is the case in the original factorial axes, but this is not of interest to the simple user who is only interested in being able to distinguish the categories of variables that determine the interpretation of the most pronounced trends of the phenomenon being examined.

The results of this research can have positive implications for the dissemination of MCA as a method and its use as an integrated exploratory data analysis approach.

Interpreting the MCA results presents difficulties for the nonexpert user and sometimes lead to misinterpretations. The interpretative difficulty persists in the MCA's other interpretative proposals. The proposed method of interpreting the MCA results clearly and accurately allows for the interpretation of its results and thus contributes to the dissemination of the MCA as an integrated method of categorical data analysis and exploration.

This paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England.

The MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed.

Results showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions.

This project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments.

The purpose of this paper is to report the findings of the Confidential Inquiry into premature deaths of people with intellectual disabilities (CIPOLD) in relation to the Mental Capacity Act (England and Wales) (MCA) 2005.

CIPOLD reviewed the deaths of all known people with intellectual disabilities (ID) aged four years and over who had lived in the study area and died between 2010 and 2012.

The deaths of 234 people with ID aged 16 years and over were reviewed. There were two key issues regarding how the MCA was related to premature deaths of people with ID. The first was of the lack of adherence to aspects of the Act, particularly regarding assessments of capacity and best interests decision-making processes. The second was a lack of understanding of specific aspects of the Act itself, particularly the definition of “serious medical treatment” and in relation to Do Not Attempt Cardiopulmonary Resuscitation guidelines.

CIPOLD did not set out to specifically evaluate adherence to the MCA. It may be that there were other aspects relating to the MCA that were of note, but were not directly related to the deaths of individuals.

Addressing the findings of the Confidential Inquiry in relation to the understanding of, and adherence to, the MCA requires action at national, local and individual levels. Safeguarding is everyone's responsibility, and in challenging decision-making processes that are not aligned with the MCA, the authors are just as effectively protecting people with ID as are when the authors report wilful neglect or abuse.

CIPOLD undertook a retrospective, detailed investigation into the sequence of events leading to the deaths of people with ID. To the authors’ knowledge, this is the first time that such research has associated a lack of adherence to the MCA to premature deaths within a safeguarding framework.

The purpose of this paper is to present an exploration of the experiences of clinical psychologists involved in implementing the Mental Capacity Act (MCA).

Seven clinical psychologists were interviewed and transcripts were analysed using thematic analysis.

Six themes were identified: competence and confidence; understanding and uncertainty; colleagues, collaboration, conflicts, and challenges; working within the law: processes and penalties; the psychological way: specialist skills and difficult decision-making; and power, principles, and protecting the person. The themes highlighted how the specialist skills and professional values of clinical psychologists enhanced their ability to maintain person-centred approaches and uphold the empowering principles underlying the MCA. Data analysis indicated a shared narrative among clinical psychologists involved in implementing the MCA, despite differences in client groups and contexts.

This research highlighted the importance of finding solutions to current problems with the implementation of the MCA, such as training gaps and misunderstanding of the Act in relation to some of its complexities (e.g. deprivation of liberty safeguards and best interests decisions). These areas have the potential to significantly impact on a person's wellbeing. There is an ongoing need for training, multidisciplinary working, and strong effective supervision with ongoing reflexivity, if the Act is to be implemented in the holistic person-centred manner that are the foundations on which it was developed.

This research identifies the important role clinical psychologists have to play in this process. Their specialist skills can encourage a person-centred approach to the implementation of the MCA.

The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 within England and Wales as a framework for making decisions about incapacitated persons' care and treatment generally not amounting to a deprivation of their liberty (although such could be authorised under its powers by the new Court of Protection). From a planned date of April 2009, the MCA is to be enlarged by the provisions of the Mental Health Act 2007 (MHA 2007) to encompass deprivation of liberty, with the addition of a new framework of Deprivation of Liberty Safeguards (DOLS). The MHA 2007 also revised significant aspects of the Mental Health Act 1983 (MHA), which were implemented in November 2008. The interface between the MCA, as amended to include DOLS, and the revised MHA is complex and potentially ambiguous. This paper describes in detail some issues that may arise at the interface of the two acts, and seeks to inform professionals involved in the use of these legal frameworks of the resulting complexity.

The purpose of this paper is to evaluate staff knowledge of Mental Capacity Act (MCA) capacity assessments within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust. The limited research available suggests staff knowledge tends to be poor, particularly concerning who is the decision maker.

A 12-item multiple choice questionnaire, which reflects the five core principles of MCA (2005), was developed. Questionnaires were completed by 262 health and social staff members who support people with LD.

Results show high variability of MCA capacity assessment knowledge within the LD division. However, qualified staff and those from health services scored significantly higher across all categories on the questionnaire compared to non-qualified and social care staff, respectively. On average, all staff scored poorly when asked to identify “who is the decision maker?” in a case scenario question.

The main limitation is that we did not collect data on how many previous capacity assessments and discussions each person had been involved with. The findings clearly suggest current methods of training lack efficacy in helping staff apply MCA knowledge to their clinical work.

Compared to past literature, this study utilised a novel and more comprehensive questionnaire. This focused on case scenario questions to assess staff situational judgement. In addition, the findings add to a sparse evidence base that provides a foundation for future research.

The Mental Capacity Act (MCA, 2005) provided a new legal framework for decision-making practice in England and Wales. This study aims to explore qualitative research on practitioners’ knowledge and experiences of the MCA in health and social care settings to inform practice and policy.

Four electronic databases and Google Scholar were searched in November 2019 for peer-reviewed, qualitative, English language studies exploring practitioners’ experiences and knowledge of the MCA in health and social care settings. Nine studies were included and appraised for methodological quality. Data were analysed using thematic synthesis.

Data revealed both positive aspects and challenges of applying the MCA in practice within five main themes, namely, travelling the “grey line”, the empowering nature of the MCA, doing the assessment justice, behaviours and emotional impact and knowledge gaps and confidence.

The fundamental principles of the MCA appear to be adhered to and embedded in practice. However, practitioners find mental capacity work remains challenging in its uncertainties. While calling for more training, they may also benefit from further MCA skills development and support to increase confidence and reduce apprehension.

This is the first systematic review to synthesise qualitative literature on practitioners’ experiences and knowledge of the MCA. Findings offer insight into practice experiences of the MCA and provide a basis for the development of training and supervisory support.

This paper seeks to present findings from a review of hospital policies and practices in one NHS Trust in England.

The focus of the review was hospital staff policy and practice in safeguarding the rights of vulnerable patients. A sample of staff was surveyed to investigate their knowledge of the Mental Capacity Act 2005 in 2010. Interviews, incorporating discussion of a vignette, were undertaken with a range of staff and findings were analysed thematically. These findings are contextualised by an analysis of Trust policies and the wider literature. The findings of this case study are used to develop recommendations for the hospital and healthcare sectors.

Analysis of survey data and interviews revealed limited confidence and knowledge about the Mental Capacity Act 2005 and uncertainties about its relevance to clinical practice. In relation to safeguarding, there was limited realisation of the potential of the Act to uphold the rights of patients lacking capacity and staff responsibilities. MCA training had not made a great impression; hospital policies were inconsistent and lacked coherence.

This case study was conducted in one Trust and may not be generalisable. Other hospitals may have different training, policy and procedure systems.

The findings of this case study may be applicable to other hospitals and to other providers of health and social care services. The relevance of the MCA could be highlighted and used on several induction and training programmes. The study identifies features of policy and practice that could be investigated in other organisations.

Few studies have investigated the operationalisation of the MCA in hospital settings. This study reveals that there are opportunities to refresh MCA and safeguarding training strategies for hospital staff but these should be accompanied by changes to culture and attention to the coherence of different procedures. Audits of MCA and safeguarding compliance can be undertaken within hospitals and a systems approach could be adopted to address any issues identified and to sustain good practice.

In March 2002, the Bush administration unveiled what it deems to be a “new global development compact”: the Millennium Challenge Account (MCA). This new compact builds upon the Millennium Development Goals, e.g. halving world poverty by 2015, put forward by 189 countries at the Millennium General Assembly at the United Nations in September 2000. However, and in stark contrast with the latter strategy, which is aimed at addressing human security issues, the MCA is tied to the objectives of the 2002 National Security Strategy of the United States. As such, the MCA is primarily aimed at bringing excluded states (or, “failed states”) into the bounds of disciplinary role of capital. For instance, one of the most novel, and coercive, features of this development compact is the “pre-emptive” method in which it will administer aid. Under the MCA, only countries that govern justly, invest in their people, and open their economies to foreign enterprise and entrepreneurship will qualify for funding. In what follows, I argue that while the form of the MCA represents an unabashed articulation of U.S.-led imperialism vis-à-vis the poorest regions in the South, witnessed by the growing privatization of development aid and military intervention, its content reflects the same goals and interests that underlie the proceeding development agenda (i.e. the Washington consensus), namely promoting the idea that the “only” path to increased growth and prosperity is to be found in countries’ willingness and ability to adopt policies that promote economic freedom and the rule of law.