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Skip to 0 minutes and 8 seconds Mental capacity is the ability to make decisions. In dementia, especially as the illness progresses, people lose the ability to communicate effectively and also the cognitive ability to make decisions. Now, dementia is an illness that increasingly affects our memory and our thinking skills. And so, inevitably, it begins to have an impact on our mental capacity to make certain decisions. In the early stages, our mental capacity might only be impaired with respect to more complex decisions. For example, somebody might have complex financial affairs where they need to manage a portfolio of shares. So the person may lose capacity to manage those sorts of decisions. But as dementia progresses, it’s likely to start to affect our abilities to make other decisions as well.

Skip to 1 minute and 3 seconds So for example, a person may no longer be able to make a decision about whether they should pay for and receive help and support from paid carers. Or they may be unable to make a decision about whether they should accept a period of respite care if their loved one is becoming particularly fatigued or stressed. Doctors and other professionals must assume that somebody has the necessary mental capacity to make a particular decision or to embark on a particular course of action, unless there’s evidence that suggests that the person lacks mental capacity.

Skip to 1 minute and 43 seconds Now, what that means is that a doctor can’t assume that just because somebody has got dementia, they haven’t got the mental capacity to make a particular decision about, for example, a medical treatment. When doctors or other professionals decide whether the person has mental capacity or not, then they have to ask themselves a series of questions. The first question they have to ask themself is, does this person have an abnormality or a disorder of their mind or brain? And really, the Mental Capacity Act only comes into play if somebody does have an abnormality or disorder of the mind or brain.

Skip to 2 minutes and 21 seconds If the person does, then the doctor then needs to consider whether that abnormality interferes with the person’s ability to make decisions. So the doctor needs to consider, is the person able to understand the information necessary to make a balanced decision? They also need to ask, if the person is able to understand that information, are they able to retain it in their minds for long enough to think about it and consider it? The Mental Capacity Act refers to people weighing the information in the balance to come to a decision. If they are able to do that, then the doctor also, or the other professional, needs to consider whether the person is able to explain what their decision is.

Skip to 3 minutes and 11 seconds So there’s really five different questions that a doctor or professional asks themselves to work out whether the person has mental capacity to make a particular decision. Making a decision in someone’s best interests means that when they have lost the capacity to make decisions or communicate their views about decisions, that you have the knowledge to actually make the decision on their behalf and that you feel confident that you know that decision you’re making is what they would have wanted.

Skip to 3 minutes and 43 seconds If the person lacks the mental capacity to make a particular decision at a particular time, then certain types of decisions can be taken on their behalf by others if those other people considered it to be in the person’s best interests to do so. Examples of decisions that can be made on behalf of the person with dementia who lacks mental capacity would be decisions concerning whether they should have particular types of medical treatment or not. Or it might involve very important decisions, such as where the person might live. Whether they were able to continue living at home or whether the time had come to move into care.

Skip to 4 minutes and 27 seconds Certain other types of decisions, though, cannot be made if the person lacks the necessary mental capacity. And an example of that would be making a will or getting married. We sometimes have to make best interest decisions that go against what she wants. Because she will say, there’s nothing wrong with me. I don’t need to go to the doctors. But actually, you can obviously see that she’s actually quite poorly. And having the documents in place has certainly made it easier for us. When you have concern for a loved one, you have to make decisions that you feel are right with what perhaps they felt in the past.

Skip to 5 minutes and 11 seconds But sometimes it’s not even that. Sometimes you have to make decisions that aren’t nice, don’t fit, don’t sit well, but the situation dictates that something has to be done which is outside the norm for you. It’s knowing that you’re doing what you’re doing for his well-being, or her.

Mental capacity and best interests

We explore what happens if the person you support is no longer able to make certain decisions about their care and welfare. Our healthcare professionals explain mental capacity and how this may change as dementia progresses. They talk about what it means to have or lack mental capacity to make certain decisions.

Our family carers also share their personal experiences about what it means to make decisions on behalf of the person, in their best interests, if they lack capacity to make their own decisions.

The Mental Capacity Act (2005) is only relevant in England and Wales.

Other countries will have their own legislation around mental capacity, which may have similar principles.

For more information on the Mental Capacity Act (2005), mental capacity and best interests, see Mental Capacity Code of Practice.

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This video is from the free online course:

Dementia Care: Living Well as Dementia Progresses

Newcastle University