How to use the mental capacity assessment support toolkit

The first part of the toolkit is a Support Tool. This is a six-page document designed to guide you through the different stages of the capacity assessment process, using a series of questions and prompts.

Pages 1 and 2 are designed to help you to complete important preparatory work prior to the actual capacity assessment. Page 1 prompts you to think about the decision the patient is being asked to make and whether you need to carry out a capacity assessment for this patient at this time. Page 2 prompts you to collect important information that y ou will need to provide to the patient when you talk to them about the decision options available to them. Page 2 also contains prompts to help you to consider different factors that may affect the patient’s decision-making. These include cultural, ethnic and religious factors, as well as any different support needs the patient may have (e.g., due to communication, cognitive, mental health or emotional diffi culties). Guidance is provided to help you to identify these different needs and ways to support them. For example, you might be prompted to seek specialist support from a colleague. You may be prompted to complete these actions before continuing to use the Support Tool during the capacity assessment itself.

Having completed pages 1 and 2, you can use the prompts and questions on pages 3 and 4 to carry out and record your capacity assessment. Page 3 includes prompts to help you to prepare the patient and the assessment environment. Pages 3 and 4 include questions corresponding to the MCA’s 4-stage functional test of decision-making abilities. There is also space for you to record evidence to support your decision about whether the patient is able to demonstrate each ability. Page 4 provides space for you to record your judgement about whether the patient demonstrates capacity to make the decision and your plan for what needs to happen next (e.g., you may need to organise a Best Interests Meeting).

Pages 5 and 6 provide an optional document on which to record your assessment fi ndings, if you do not have enough space on pages 3 and 4. It includes prompts taken from the NICE guideline “Decision-making and mental capacity” NG108 (NICE, 2018). The guideline is available here.