A Clinician’s brief guide to the MCA (Brindle, Branton, Stansfield & Zigmond) – Book Review

 In Book Reviews for Private Client practitioners, Elderly/Vulnerable Client

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This is an easy-read guide to understanding those parts of MCA 2005 which clinicians need in their daily practice.  It should also aid the understanding of everyone who helps care for people who cannot make decisions for themselves or who wish to make legal provision for their own future care.  It is not a book directed at lawyers.

Chapters 1 & 2 provide useful guidance on the key principles behind the MCA and its application.

Chapter 3 will interest lawyers as it gives guidance on the assessment of capacity.  It is entirely referable to the Act and not to the different legal tests for undertaking specific acts eg. making a Will.  Incidentally on p26 the book says “solicitors maybe responsible for assessment of capacity in relation to their clients’ legal transactions.”

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It usefully reminds clinicians that a request for an assessment may come from a solicitor and should therefore be accompanied by an explanation of the legal test to be applied.  It recommends the clinician asks for the reasons why a medical opinion is sought and why the matter is contentious or disputed.

The book talks about other tools’ resources apart from medical records and the views of family and friends:

  • A standardised assessment such as Barthel Index – baseline level of functioning to evaluate activities of daily living
  • A screening tool – MMSE to provide objective evidence of cognitive impairment
  • Addenbrooke’s Cognitive Examination (ACE-III) – more detailed examination.

In some cases specialised neuropsychological assessments may be needed. 

Diminished capacity is associated with impairments in memory, executive function and comprehension.

Cognitive functions are listed together with suitable tests – these are quite interesting.

Chapter 4 on acting in the patient’s best interests should provide guidance to anyone acting formally under a PoA or Deputyship and those acting informally because the patient resides with them.

Chapter 5 deals with advance decisions to refuse treatment and LPAs.

Chapter 6 describes the role of the Independent Mental Capacity Advocate service.  Lawyers will be interested to know this service is provided for any person aged 16 or older through referral arrangements, who have no-one to support them and they are unable to make their own decisions; or where there are disputes as to the patient’s best interests between eg family members.

Chapter 7 deals with deprivation of liberty safeguards – these provisions provide an additional legal framework that affords greater protection for mentally incapacitated people who require a high level of care, whether in hospital or elsewhere but who fall outside the scope of MHA 1983.  Some of the leading cases are considered.  The use of the MCA or MHA is compared and contrasted.

Chapter 8 discusses the Court of Protection (CoP) and Court appointed deputies.  It explains the functions of the CoP, who can be appointed as a deputy by the Court.  It also suggests how to write reports for CoP.

Chapter 9 examines the MHA which authorises compulsory admission to and detention in hospital and medical treatment for persons with mental disorders.

This slim volume therefore does not address issues of concern to the lawyer such as the ease of access to specialist clinicians for capacity assessments to undertake specific legal acts, such as making an LPA or a Will, nor does it consider the pressures on solicitors to act promptly.

Nevertheless it is a useful overview of the MCA for people involved in the care of elderly people and provides insight into the aspects of concern for clinicians.  It demonstrates the difficulties of making a judgment and will help lawyers understand assessment tools and reports from clinicians.

It costs £18 and is published by the Royal College of Psychiatrists. Available on Amazon…

25 Apr 2014

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