MCA 2005

Question 1

5 key principles of the MCA (Section 1)

Assessment of MC (Section 2, 3)

Answer 1

16+

Assume capacity unless proved otherwise
Support in decision making
Unwise decisions ≠ no capacity
Any decisions made for someone without capacity must be in best interests
Treatment and care should be the least restrictive

Do they have impairment of mind/brain
-Understand, retain, weight, communicate decision?

Question 2

Best interests decision guidance in MCA (Section 4 (assess BI), 5 (acting in BI without restraint))

Answer 2

Can the decision be postponed or necassery?
Could they regain capacity?

Identify personal views and wishes
Do they have any written advance statement/decision documents? LPA?
Consult close relatives, carers and friends

Question 3

What are the key principles in DOLS (MCA)

-when would you need to ask for DOLS authorisation

Answer 3

Detain someone for medical treatment, no capacity

Must answer yes to both questions

• are they under constant supervision and control? (do they have complete and effective control over a patient’s care, movements and decisions?)
• are they not free to leave? (if the patient tried/asked to leave, would care staff try to stop the person from leaving?)

Question 4

Urgent DOLS authorisation

• timeframe active and location
• what applications need to be done
• extensions

Answer 4

Urgent - 1 week, hospital/care home

• when DOL needs to start before standard authorisation can be obtained and will only last a short time
• apply for standard/urgent
• 1wk extension within same admission

Question 5

Standard DOLS authorisation

• timeframe active and who authorises it
• when is it granted
• extensions

Answer 5

Standard - 1 year, local authority

• assessors decide if DOLS is in best interests
• 1 year extension

Question 6

Section 6 of MCA

How does this differ from DOLS?

Answer 6

Restraint used when protection from the use of/threat of force is needed

Restraint must be
-proportionate to likelihood and seriousness of harm
-other less restrictive methods have been tried and failed
Must document rationale and action taken

If restraint is used often and other decisions that significantly restrict liberty have been made

• consider if DOLS
• change the care plan

Question 7

How would you communicate with low risk patients

• no immediate danger
• cooperative

Answer 7

Understand and meet basic needs
-phone charging, food, drink?
Trauma informed approach
-'What's happened to you'?
Keep patients informed, manage expectations

Question 8

How would you communicate with escalating risk patients

-uncooperative but not actively resistive or aggressive

Answer 8

Same approach as low risk patients
Verbal de-escalation/redirection
Solution focused (who can we call that may help?)

Question 9

How would you communicate with high risk patients

• requires immediate action to prevent harm to self, others, property
• behaviour aggressive, violent

Answer 9

Same approach as escalating risk patients
Manage environment => remove hazards
Regularly review care planning

May need

• physical restraint
• sedation (offer BZ/antipsychotics, administer IM lorazepam)