Experiences of assessing mental capacity in England and Wales: A large-scale survey of professionals
Open accessAbstract
Background: The Mental Capacity Act (2005) of England and Wales described in statute a test to determine whether a person lacked the “mental capacity” to make a particular decision. No large-scale survey has explored experiences of capacity assessment across professional groups. Methods: We administered an opportunistic self-report questionnaire survey of professionals who undertake capacity assessments in England and Wales (n= 611). Topics of interest included; how often and where capacity assessment took place, self-ratings of competency and challenges experienced in assessment, use of psychological testing and concerns about undue influence. We analysed the quantitative responses using a mixed-methods approach using regression methods for the quantitative ratings and a thematic analysis for qualitative data. Results: Our sample included 307/611 (50.2%), social workers, 89/611 (14.6%) psychiatrists, 62/611 (10.1%) nurses, 46/611 (7.5%) clinical psychologists, 30/611 (4.9%) doctors from other medical specialties, 12/611 (2.0%) speech and language therapists and 8/611 (1.3%) solicitors. 53% of these professionals undertook more than 25 capacity assessments per year, with psychiatrists, social workers and nurses undertaking them the most frequently. Most professionals reported high self-ratings of confidence in their assessment skills, although non-psychiatrist doctors rated themselves significantly lower than other groups (p< .005). Most professionals (77.1%) were at least moderately concerned about undue influence, with people with dementia and learning disabilities and older adults considered to be the most at risk. Qualitative themes for challenges in capacity assessment included inter-disciplinary working, complicated presentations and relational issues such as interpersonal influence. Requests for support mainly focused on practical issues. Conclusions: Most professionals feel confident in their ability to assess capacity but note substantial challenges around practical and relational issues. Undue influence is a particularly common concern amongst professionals when working with service users with dementia and learning disabilities which public services and policy makers need to be mindful of.
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Fluctuating or borderline capacity cases are among the most challenging to assess.
“Finally, previous studies have also noted that inter-rater disagreements are more likely when the patient's capacity is fluctuating or borderline (Dunn et al., 2007) and that these cases are among the most challenging to assess (Ariyo et al., 2021).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Ariyo et al., 2021
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- Authors
- Ariyo, K., McWilliams, A., David, A. S., & Owen, G. S.
- Affiliations
- King's College London (GB)
- Wellcome Centre for Human Neuroimaging (GB)
- University College London (GB)
- Corresponding author
- Ariyo, Kevin
- Venue
- Wellcome Open Research
- Publisher
- F1000 Research Ltd
- Published
- 2021-06-10
- Volume
- 6
- Pages
- 144
- ISSN
- 2398-502X (ISSN-L)
- PMC
- PMC8246303
- OpenAlex
- W3169291037
- Cited by
- 11
- References
- 31
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 2 · 2022: 1
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Wellcome Open Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- UCLH Biomedical Research Centre
- Wellcome Trust (203376)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- mental capacity assessment, Mental Capacity Act 2005, professional experience, professional confidence, undue influence, dementia, learning disabilities, older adults, psychological testing, social workers, psychiatrists, nurses, clinical psychologists
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