Capacity and its assessment

The following is a stepwise summary of capacity assessment for your MRCPsych CASC Exams

Assessing Capacity:  

Definition of capacity:  

The capability to make a specific decision at a specific time.  

Common scenarios where capacity assessment is needed: 

Capacity to  
  1. Refuse/accept treatment.  
  2. refuse/accept an intervention for assessment.

It is the responsibility of the persons treating them to assess capacity.  

Steps of Assessing Capacity  

Step 1

Check if there is an impairment of  

  • The mental abilities 
  • Whether permanent or temporary 

Step 2:   

Check for the following 

  • They can understand the information relating to the decision required 
  • They can retain the information long enough to decide 
  • They can use or weigh the information as part of making the decision 
  • They can communicate their decision 

Step 3:  
  • If the person passes the test of capacity 
  • If they have made the right decision -we must respect this 


If the right decision has NOT been made:  

  1. Express your concerns and explain that they have not made the best decision.
  2. Give them time to think about their decision.
  3. Encourage them to talk to their treating team.
  4. Agree to see them again 


If a person fails the test of capacity, a health or social care decision may have to be made in their best interest. We consider several things before we do this: 

  1. The current circumstances (diagnosis, care needs, etc.) 
  2. A person’s beliefs and values 
  3. Person's past and present wishes and feelings 
  4. Others involved in the person's care should be consulted 
  5. Will the person regain capacity? 
  6. If so, can it wait? 
  7. Is there the least restrictive option available? 
  8. Is the decision based solely on the person’s age, condition, or behavior? 


For life-sustaining treatments, a desire to bring about a person’s death must not motivate the decision. 



Guiding Principles 


  1. We assume an adult to have capacity unless proven otherwise 
  2. A mental disorder does not automatically make someone incapable of making health-care decisions 
  3. People may make their own decisions based upon their own value system, even if this is irrational by the standards of the assessor! 
  4. We must take practical steps to help an individual decide 
  5. Explore the reasons for the decision and provide information. 
  6. We should not treat a person as lacking capacity simply because they make a wrong decision, 
 

Step 2 details

The following explains the

  • Understanding the Information

    We have informed the patient in level with his capacity for comprehension. Type of treatment, and what it entails, benefits and risks of the treatment implications of refusal, alternatives to the proposed treatment

  • Retain the Information

    Can the patient recall or paraphrase the discussion? Deficits are often apparent during the assessment. Cognitive testing may help.

  • Weigh up the Information

    Can they explain the steps? That now needs to be taken. Can they apply the information? To their own situation. Can they weigh up the risks and benefits of options?