The Mental Capacity Act 2005 and
Patient Participation in Decision Making:
A Community Engagement Project
Janet Lawrence
Mental Capacity Act/Safeguarding Adults Practitioner
Mary Partridge
Lead Nurse for Safeguarding Adults
Overall Aim of the Paper
To provide an overview of a community
engagement project to increase public
awareness of how the Mental Capacity Act
2005 (MCA) supports patient participation
and shared decision making
Learning Outcomes
For delegates to have:
• An overview of the MCA principles and its relevance
to patient participation and shared decision making
• An awareness of how a community engagement
approach has been successfully applied to promote
public awareness of the MCA in a diverse community
• Knowledge of the benefits of utilising service user
involvement and a multi-agency approach to facilitate
and promote patient empowerment, autonomy and
choice in healthcare decisions
Project History
• The MCA – five key Principles
• Embedded in the protection and
safeguarding of vulnerable adults
• A nurse-led project responding to unmet
needs in Birmingham
• Maximising health and social care
decision making for patients and carers
to increase public awareness in
Birmingham of how the MCA supports
healthcare decision making
• Overall aim to increase public awareness
in Birmingham of how the MCA supports
healthcare decision making
MCA Principles
• A person must be presumed to have capacity
• Individuals must be supported to make their decisions
• A person should not be treated as unable to make a
decision because they make an unwise decision
• A decision made or act carried out on behalf of a person
who lacks capacity must be made in their best interests
• The best interest decision must be the least restrictive way
in valuing the person’s rights and freedom
Shared Decision Making…?
“Shared decision making will become the norm; no decision about me without me”
(Department of Health, 2010)
“I have spoken to an Imam about MCA and he feels this needs to be widely aired
as he himself has been dealing with families arguing about who has the authority
to act on behalf of an elderly relative”
(service user, Birmingham)
Two million people in England and Wales are believed to lack capacity to make
decisions for themselves with an estimated six million people providing care for
those who lack capacity (Social Care Institute for Excellence, 2009)
People with learning disabilities making major decisions were routinely deemed
unable to make decisions and unwise decisions were often taken as incapacity
(Norah Fry Research Centre, 2008)
There is a need for increased awareness to Black Minority Ethnic communities of
the MCA. “Decision making” and “capacity” are too complex for people to engage.
“The Act is up there and people are somewhere else” (Mental Health Foundation,
Targeting Unmet Need to
Promote Shared Decision Making
Community engagement:
‘community engagement’ is a
process of community involvement
with decisions that impact them. It
can provide a framework and
strategy for the planning,
development and implementation of
health projects
Establishing a model
Project proposal
Building community capacity
Achieving health outcomes
The Community Engagement
Outcomes and Indicators
Aim 1:
Public awareness of the Principles
of the MCA increased
Three MCA workshops (40
people per workshop including
20 service user group
Increased enquiries to OPG in
Increased access or ‘traffic’ –
webhits to Trust website
Distribution of MCA resources
Aim 2:
Public access to MCA resources
Public awareness of MCA rights
Aim 3:
Patients and carers feel confident
to participate and challenge
healthcare decision making
Their healthcare decision making
experience is improved
Increase in confidence to
participate and challenge
decision making
Stakeholder Engagement and
Steering Group
Service user involvement
Patient and Public Involvement team
Office of the Public Guardian
Legal services
The Pension Service
NHS staff
Local authority staff
Independent Mental Capacity Advocacy (IMCA)
• Local GPs
The Workshops…
“Positive and friendly – a genuinely public centred event”
“A very good workshop”
“Very educational”
“Very good. Really enjoyed the session”
“I think more workshops like this are needed”
Stakeholder and Panel Members:
“Thank you for inviting the Office of The Public Guardian to participate in your workshops. A very rewarding experience”
Quality Review Manager – The Office of the Public Guardian
“I found it really informative and forged some excellent contacts. I feel I have a much more rounded perspective of an
individuals autonomy in their own decision making from many different perspectives”
Partnership Support Manager, The Department for Work and Pensions
“I really enjoyed the afternoon and also the opportunity to listen to the other speakers”
“A very good programme”
Birmingham City Council
A Carers Story
From an early age, Mrs A cared for her mother who
had challenging behaviour as a result of a
combination of mental health issues. Although her
mother passed away two years ago, through her
knowledge of the Mental Capacity Act and by
registering herself as her mother’s ‘Lasting Power of
Attorney’, Mrs A was able to ensure that her mother
got the care she needed – something she now
believes added years onto her mother’s life…
Progress and the Next
One to Two Months
Four workshops delivered
154 delegates attended – patients, carers and
community groups
Delegate diversity – age, ethnicity, gender and
32 MCA Champions
2,800 resources distributed
2,300 web hits on
Evaluation and final report in progress – interim results
show an increase in learning and confidence for
delegates to apply the MCA during consultations
Moving Forward
• Mental Capacity Champions – to champion the Act
and help people find out more information should
they need it by distributing the resources and
• Continued partnership working – ongoing
opportunities to build capacity and capability within
the organisation and community
• Further opportunities – to link in with other relevant
health and social care agendas and campaigns, for
example NHS Summary Care Records and other
service user groups
Thank You for Listening
...any questions?
Mary Partridge – Lead Nurse for Safeguarding Adults
E-mail: [email protected]
Janet Lawrence – Mental Capacity/Safeguarding
Adults Practitioner
E-mail: [email protected]