Rough Sleeper Project

Death of Rough Sleeper 2010 Discharged by MH services following

eviction Seen rough sleeping by police and LAS

but no intervention taken SCR recommended development of MCA

screening tool

1

To intervene or not?‘There is a risk that all professionals involved in helping and treating that person…may feel drawn towards an outcome that is more protective of the adult and thus, in certain circumstances, fail to carry out an assessment of capacity that is detached and objective’ (CCv KK and another [2012] EWHC 2136 (COP) para.25)  

2

To intervene or not?

‘It is essential that health and social care services review the implications of acceding to people’s “choice” if the latter is not to be construed as abandonment’ (Cornwall Adult Protection Committee, 2007, paras 5.13, 5.16 in SCIE (2011) Safeguarding adults at risk of harm: A legal guide for practitioners p164).

Simple Schizophrenia ICD - 10An uncommon disorder in which there is an insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance....

.....the characteristic “negative” features of residual schizophrenia (e.g. blunting of affect, loss of volition) develop without being preceded by any overt psychotic symptoms.

...with increasing social impoverishment, vagrancy may ensue, and the individual may then become self-absorbed, idle, and aimless.’

4

Mental Capacity Act 2005

Screening Tool developed for outreach teams

Clarify whether the person is making a lifestyle choice

Provide information to inform MHA assessments and ward teams

5

MCA - Overview

A functional test of capacity Best Interest approach to decision making Powers of Attorneys/Advance decisions Court of Protection Independent Mental Capacity Advocates

Purpose of MCA assessment Tool• Test whether someone is making a lifestyle choice.• Assist/prompt LAS to complete their MCA assessment. • Provide evidence for a Mental Health Act assessment.• Support the rationale for a hospital admission.

MCA - The Principles 1

• A person must be assumed to have capacity unless it is established that he lacks capacity.

• A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

• A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

MCA –The Principles 2 An act done, or decision made, under this Act for

or on behalf of a person who lacks capacity must be done, or made, in his best interests.

Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

What is capacity?

‘….legal capacity depends upon understanding rather than wisdom: the quality of the decision is irrelevant as long as the person understands what he is deciding’

(Law Commission 1991)

Capacity Test

Decision Specific. Time Specific. Capacity Test is made by the person

taking the action in the person’s best interest.

Stage1.

Must have reason to believe that the person has:

‘an impairment of, or a disturbance of, the

mind or brain’

(MCA Section 2)

Stage 2:Functional Test of Capacity

Understand the information Retain the information Use and Weigh up the Information Communicate the decision

S136 Mental Health Act

‘If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety within the meaning of section 135 above.’

14

Hospital Admission Plan

Gives a clearer rationale for admission Highlights role of outreach team Challenges myth of lifestyle choice Highlights risk (clean pyjamas syndrome) Where time allows joint planning between AMHP

and outreach service

15