What is mental capacity? The severity of a stroke can be life changing, to the extent that the person you love can no longer have the ability to make decisions about their life and what’s best for them; this can be as simple as staying in a hospital to recover or larger decisions such as stopping treatment.

What is Mental Capacity?

Mental capacity means you have the ability to make your own decisions.  This means you are able to understand and think through information given to you and then you make your decision and choice based on this information.

All of us struggle to make certain decisions in life, especially those we haven’t had previous experience of. However struggling or being indecisive is not the same as not having the capacity.

The Mental Capacity Act 2005 is designed to protect individuals and support those who may lack the mental capacity to make decisions about their care, treatment, placement and any other decision they entail.

Important points:

  1. Someone’s lack of mental capacity can be temporary for example due to infection or initial brain injury. For others, lacking capacity can be permanent.
  2. The assessment of someone’s capacity is decision specific; therefore every decision which needs to be made requires a separate assessment. Just because someone cannot make a decision about their complex financial affairs does not mean they are unable to decide what they would like to eat or drink.

How does someone’s capacity get assessed?

Within the context of the healthcare service, someone’s capacity can be assessed by a doctor, a healthcare professional or a social worker.  If someone has a communication difficulty due to a brain injury then a speech and language therapist will advise and facilitate an assessment to ensure that the information is given to the individual in the most accessible way.  This can be through pictures, simple single words or simple yes/no questions. The assessment must be made as patient centred and accessible as a possible to ensure the person is given every opportunity to understand the information and the decision being made.

There are 4 stages to assessing someone’s capacity for each individual decision, and the individual must demonstrate that are able to carry out each stage.

  1. An individual must understand the information given to them.
  2. An individual must retain that information, there and then in the assessment
  3. An individual must be able to weigh up the information and what the choices are in relation to that decision
  4. An individual must be able to communicate their decision to the assessor. This can be in any form of communication.


What happens if someone hasn’t got capacity?

If someone hasn’t got the capacity to make the decision in question then a decision will be made in their ‘best interest’.  In order for the decision to be in someone’s best interest the individuals wants will be taken into consideration, along with the information from people who know them best and who would know the individuals wishes.   If the decision is medical, then the decision maker tends to be a doctor.

How to prepare for the future

Anyone can plan for the future and ensure their wishes are known or hand over the responsibility of making decisions to another person they trust.  This can be achieved in various ways:

Important things to remember:

  • Everyone is deemed to have the capacity until proven otherwise
  • Capacity is decision specific

Written by Rachel Dines, Speech and Language Therapist