Mental Capacity Assessment

In the event of staff having concerns over a customer’s ability to make decisions, please refer to the following questions:

What is the issue that the customer needs to make a decision about?

Please list details below:

Does the person have any known medical conditions that might impede their ability to make decisions?                   Yes  No   (please circle)

Can this decision be delayed until a more appropriate time in the future?                                      Yes      No       (Please circle)

1.       Can the person understand the question or situation they need to make a decision about?            Yes         No              (Please circle)

2.       Can the person retain or remember this information for any length of time?                          Yes      No              (Please circle)

3.       Can the person weigh up this information enough to make a decision?                                Yes        No              (Please circle)

4.       Can the person communicate this decision?                                                        Yes        No              (Please circle)

Staff member completing this assessment: ……………………………………………………………. Date: ……………………………………………..

 To assess the customer's mental capacity appropriately, this test needs to be completed twice (over two days) to make sure the customer isn’t just having a bad day. Please repeat if the concern remains.

What is the issue that the customer needs to make a decision about?

Please list details below:

Does the person have any known medical conditions that might impede their ability to make decisions?                   Yes  No   (please circle)

Can this decision be delayed until a more appropriate time in the future?                                      Yes      No       (Please circle)

1.       Can the person understand the question or situation they need to make a decision about?            Yes         No              (Please circle)

2.       Can the person retain or remember this information for any length of time?                          Yes      No              (Please circle)

3.       Can the person weigh up this information enough to make a decision?                                Yes        No              (Please circle)

4.       Can the person communicate this decision?                                                        Yes        No              (Please circle)

Staff member completing this assessment: ……………………………………………………………. Date: ……………………………………………..

Client Name…………..……………………………………                                 Date …………………………

Staff Name …………………………………………………………………                 Signature ………………………………………………………

If the person being assessed cannot understand, retain, weigh up and communicate  a decision based on considering the information then a ‘best interests’ decision needs to be made.  Please ensure this is completed as soon as possible and follow the guidance on ‘Best Interests’ decisions, and involve family, other relevant professionals and significant others in this process.  This must also be reflect in all care planning and risk assessment paperwork.