​A mental capacity assessment is undertaken to establish whether a person has the capacity to make a specific decision at the time that decision needs to be made.

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In England and Wales, it is governed by the Mental Capacity Act 2005, which provides the legal framework for assessing whether a person is able to make a particular decision for themselves.

Mental capacity is always decision-specific and time-specific and it is not uncommon to find that a person may have capacity to make some decisions but not others, and their capacity may also change over time.

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The starting point is always the presumption that a person has capacity. Before concluding that a person lacks capacity, all practicable steps must also be taken to support them to make the decision themselves.

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How is Mental Capacity Assessed?

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A mental capacity assessment focuses on the specific decision that needs to be made and the information that is relevant to that decision.

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As part of the assessment, I identify the relevant information and assess the person’s ability to:

• understand the information relevant to the decision;

• retain that information for long enough to make the decision;

• use or weigh that information as part of the process of making the decision; and

• communicate their decision​

These elements are considered in relation to the particular decision being assessed.

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Diagnosis Does Not Mean Lack of Mental Capacity

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Having a diagnosis of dementia, a learning disability, a mental health condition, an acquired brain injury or another condition affecting the mind or brain does not, in itself, mean that a person lacks mental capacity.

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The assessment considers whether the person has an impairment of, or disturbance in the functioning of, the mind or brain and, where they are unable to make the particular decision, whether that inability is because of the impairment or disturbance in the functioning of, the mind or brain. The required connection between the impairment or disturbance and the person’s inability to make the decision is often referred to as the causative nexus.

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What if Someone Makes an Unwise Decision?

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Mental capacity is not determined by whether other people agree with the decision a person makes.

One of the fundamental principles of the Mental Capacity Act 2005 is that a person must not be treated as unable to make a decision merely because they make an unwise decision.

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My role as an independent mental capacity assessor is therefore not to decide whether I believe the person is making the right decision. The assessment considers whether the person has the ability to make that particular decision for themselves.​ 

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