Everything care providers need to know about the Mental Capacity Act 

Mental capacity in adult social care


As we age, our bodies and minds may not function as well as they used to. Even making small decisions can be a challenge.  

Sometimes, care home residents may have difficulties making decisions, either all or some of the time, about their health, welfare and finances. The Mental Capacity Act enables people to plan for these situations. 



What is the Mental Capacity Act? 

The Mental Capacity Act 2005 (MCA), designed to protect and empower people, is a legal framework that governs decision-making for adults who may be unable to make particular decisions. The Mental Capacity Act ensures that adults can make decisions for themselves or that any decisions made on their behalf are in their best interests.  

Capacity and incapacity

What is capacity? 

Our decision-making capacity is the ability to make decisions or take actions that influence our lives, from simple decisions about what to wear for the day or what to eat for breakfast to more complex decisions about the care and treatment we receive. In a legal context, it refers to an individual's ability to do something, including making a decision that may have legal consequences for themselves or others. 

When does a person lack capacity? 

A person lacks capacity if they are unable to make or communicate a decision because of an impairment or a disturbance in the functioning of the mind or brain - this can result from a range of reasons, including mental illness, learning disability, dementia or brain damage. 

What are the five principles of the Mental Capacity Act? 

The Act outlines five essential principles that health and social care staff must adhere to.  

These principles include: 

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Principle 1: Presumption of capacity

Every adult has the right to make their own decisions and should be considered capable of doing so unless proven otherwise .

This means that you cannot assume someone is unable to make their own decisions based on a particular medical condition or disability.


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Principle 2: Support to make a decision
Before anyone assumes that a person is unable to make their own decisions, they must be given all possible assistance - this includes making an effort to encourage and support individuals to make choices on their own.
Even if it is determined that a person lacks capacity, it is still important that you involve the person as far as possible in making decisions. 
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Principle 3: Ability to make unwise decisions
Individuals have the right not to be treated as lacking capacity simply because they make a decision others may view as 'unwise'.
Each person has their own set of values, beliefs and preferences, which may differ from those of others.  
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Principle 4: Best interests
Any action taken on behalf of a person who lacks capacity must be done in their best interests. 
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Principle 5: Least restrictive alternative
When someone is making a decision or taking action on behalf of a person who lacks the ability to make decisions, they must consider if there is a way to make a decision or take action that is less restrictive of that individual's fundamental rights or freedoms.
They should also consider whether there is a need to make a decision or take action at all. Any intervention should be weighed up in the particular circumstances of the case.   

Mental Capacity and Deprivation of Liberty Safeguards (DoLS)

The Deprivation of Liberty Safeguards (DoLS) give legal protection to vulnerable people in care homes who cannot consent to the care and treatment they need because they lack capacity. 

DoLS are an important part of the Mental Capacity Act 2005. Care organisations should apply them where a person aged 18 or over lacks capacity to consent to their care arrangements and needs to be deprived of their liberty - this involves continuous supervision and control and means the individual is not permitted to leave the place where they are being cared for.  

For example, an individual may need to be kept away from situations or places where their safety could be at risk, such as railway lines or busy roads. So, DoLS may be used to prevent them from leaving their care home. 

DoLS are important human rights safeguards; they aim to ensure that such deprivation of liberty only occurs when necessary, proportionate and in the individual's best interests. 

To learn more about Deprivation of Liberty Safeguards (DoLS), head over to the Care Quality Commission (CQC) website, where they discuss the legal framework in more detail.  

When might care providers need to assess capacity? 

Assessing a person's capacity becomes necessary when they are unable to make a particular decision at a particular time because their mind or brain is affected by illness or disability.  

It's important to note that lack of capacity may not be permanent. Assessments of capacity must be time and decision-specific. You cannot decide that someone lacks capacity based on age, appearance, condition or behaviour alone. 

Who can assess capacity? 

Assessors can be anyone – family members, care workers, care service managers, nurses, doctors or social workers. Any individual who makes decisions on behalf of others is responsible for recognising their role and responsibilities under the code of practice. However, in cases involving complex or major decisions, you may need to get a professional opinion - the assessor must be an impartial, qualified professional, such as a doctor, nurse, or social worker. 


It is possible for anyone to find themselves in a situation where they need to assess capacity. In particular, people working in health and social care services may have to assess someone's capacity to make a decision. Therefore, care providers must have copies of the Act's codes of practice available for relevant staff who may have to make such an assessment. 

In the codes of practice, the people who decide whether a person has the capacity to make a particular decision are referred to as 'assessors' - this is not a formal legal title.  

How do you assess capacity?

Person Centred Software has partnered with Comentis. This award-winning vulnerability assessment platform, integrated into our digital social care record system, mCare, helps care organisations proactively identify and triage at-risk clients to help assess mental capacity and identify the vulnerable. 

Comentis's Mental Capacity Assessment tool aligns with the two-stage test of the Mental Capacity Act and meets Principles 1-3, which relate to the assessment of capacity.  

To learn more about Comentis and its Mental Capacity Assessment tool, click here to book a demo.