Practitioners’ experiences of the mental capacity act: a systematic review

2020 ◽  
Vol 22 (4) ◽  
pp. 227-244
Author(s):  
Jade Scott ◽  
Stephen Weatherhead ◽  
Gavin Daker-White ◽  
Jill Manthorpe ◽  
Marsha Mawson
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Social Care ◽  
Mental Capacity ◽  
Quality Data ◽  
Emotional Impact ◽  
Supervisory Support ◽  
Content Type ◽  
Health And Social Care ◽  
Mental Capacity Act

Purpose The Mental Capacity Act (MCA, 2005) provided a new legal framework for decision-making practice in England and Wales. This study aims to explore qualitative research on practitioners’ knowledge and experiences of the MCA in health and social care settings to inform practice and policy. Design/methodology/approach Four electronic databases and Google Scholar were searched in November 2019 for peer-reviewed, qualitative, English language studies exploring practitioners’ experiences and knowledge of the MCA in health and social care settings. Nine studies were included and appraised for methodological quality. Data were analysed using thematic synthesis. Findings Data revealed both positive aspects and challenges of applying the MCA in practice within five main themes, namely, travelling the “grey line”, the empowering nature of the MCA, doing the assessment justice, behaviours and emotional impact and knowledge gaps and confidence. Practical implications The fundamental principles of the MCA appear to be adhered to and embedded in practice. However, practitioners find mental capacity work remains challenging in its uncertainties. While calling for more training, they may also benefit from further MCA skills development and support to increase confidence and reduce apprehension. Originality/value This is the first systematic review to synthesise qualitative literature on practitioners’ experiences and knowledge of the MCA. Findings offer insight into practice experiences of the MCA and provide a basis for the development of training and supervisory support.

Frailty – from bedside to buzzword?

2015 ◽  
Vol 23 (3) ◽  
pp. 120-128 ◽  
Author(s):  
Jill Manthorpe ◽  
Steve Iliffe
Keyword(s):  
Policy Development ◽  
English Language ◽  
Social Care ◽  
Content Type ◽  
The Public ◽  
The Social ◽  
Health And Social Care ◽  
The Subject ◽  
To Come ◽  
Recent Policy

Purpose – The purpose of this paper is to explore common usage and understanding of the term “frailty”, which is increasingly used in health care debates in England. Design/methodology/approach – This is a commentary from the perspectives of health and social care researchers. Recent policy and research are drawn upon in the arguments presented. Findings – Most research on the subject of frailty comes from clinical practice although a parallel sociological or gerontological critique of the social construction is emerging. The public is likely to come across the term frailty through the media’s adoption of the term. Different definitions of frailty mean that estimates of the numbers of “frail people” will vary. Research limitations/implications – The commentary draws on material in the English language and on policy, commentary, and research material. Practical implications – The commentary may prompt reflection in practice and policy development on the usage of the term frailty and promote efforts to ensure that its meaning is clear and that it is acceptable to those to whom it is applied. Originality/value – The paper contributes to debates about frailty by considering the implications of using the term across health and social care and in integrated settings and encounters. It draws on medical presentations of the term frailty and on critiques of it as a powerful discourse.

Operationalising the Deprivation of Liberty Safeguards (DoLS) in support of brain injury survivors – views from practice

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jade Scott ◽  
Stephen Weatherhead ◽  
Jill Manthorpe
Keyword(s):  
Decision Making ◽  
Brain Injury ◽  
Social Care ◽  
Legal Framework ◽  
Content Type ◽  
Health And Social Care ◽  
Mental Capacity Act 2005 ◽  
Decision Making Styles ◽  
Tentative Explanation ◽  
Mental Capacity Act

Purpose Deprivation of Liberty Safeguards (DoLS), as part of the Mental Capacity Act 2005 (DoLS, 2007), was established to provide a legal framework for decision-making in respect of adults who lack capacity to make decisions in relation to their care and residence in England and Wales. The purpose of this study was to explore the DoLS decision-making process from the perspectives of health and social care practitioners when working with individuals with an acquired brain injury (ABI). Design/methodology/approach A total of 12 health and social care practitioners were interviewed in 2019–2020 about their experiences of using and making or supporting decisions in the DoLS framework with ABI survivors. Data were analysed, and a tentative explanation of variations in DoLS decision-making was developed. Findings Three distinct approaches emerged capturing different decision-making styles (risk-averse, risk-balancing and risk-simplifying) which appeared to influence the outcome of DoLS assessments. A range of mediating factors seemed to account for the variability in these styles. The wider contextual challenges that impact upon practitioners’ overall experiences and use of DoLS processes in their ABI practice were noted. Research limitations/implications The findings highlight a need for changes in practice and policy in relation to how DoLS or similar processes are used in decision-making practice with ABI survivors and may be relevant to the implementation of the Liberty Protection Safeguards that are replacing the DoLS system. Originality/value To the best of the authors’ knowledge, this is the first study to explore accounts of DoLS decision-making practices in ABI service.

Positive risk-taking: from rhetoric to reality

2016 ◽  
Vol 11 (2) ◽  
pp. 122-132 ◽  
Author(s):  
Steve Morgan ◽  
Nick Andrews
Keyword(s):  
Risk Taking ◽  
Mental Capacity ◽  
Content Type ◽  
Care Services ◽  
Health And Social Care ◽  
Mental Capacity Act 2005 ◽  
Legislative Framework ◽  
Mental Capacity Act ◽  
Almost All ◽  
Dementia Services

Purpose – For health and social care services to become truly person-centred requires a fundamentally positive mindset from professionals and care workers, and a willingness to take some risks. The purpose of this paper is to explore how this will apply to delivering dementia services, where almost all of the initial impressions are of deficits, disability and disadvantage. Design/methodology/approach – The co-authors combine their knowledge and experience of supporting and developing staff working in dementia services. The concept of positive risk-taking is explored within the legislative framework of the Mental Capacity Act 2005, Safeguarding and the Care Act 2014. Findings – Practitioners face a range of challenges when it comes to supporting people living with dementia to take risks through exercising personal choices and making their own decisions. However, the concept of positive risk-taking applies equally to people living with dementia who have or who lack mental capacity in relation to their decision making. Originality/value – This paper places positive risk-taking within a context of strengths-based, values-based and relationship-based working. Practical tips are offered for putting positive risk-taking into practice.

scholarly journals Elder abuse screening tools: a systematic review

2017 ◽  
Vol 19 (6) ◽  
pp. 368-379 ◽  
Author(s):  
Louise McCarthy ◽  
Susan Campbell ◽  
Bridget Penhale
Keyword(s):  
Systematic Review ◽  
Social Care ◽  
Elder Abuse ◽  
Meta Analysis ◽  
Final Analysis ◽  
Screening Tools ◽  
Clinical Environment ◽  
Validity And Reliability ◽  
Content Type ◽  
Health And Social Care

Purpose Elder abuse results in high rates of morbidity and mortality. It has longstanding physical and psychological effects and is difficult to detect. Due to fear or embarrassment, victims may make attempts to hide it rather than to disclose and professionals are often reluctant to report it as they may worry about worsening a situation. If detected early enough, serious harm can be prevented and lives saved. Screening and screening tools can assist health and social care practitioners to detect abuse. This review of screening tools was undertaken as part of an MSc in clinical research, funded by the National Institute for Health Research; the purpose of this paper is to report on the review and its findings. Design/methodology/approach This was a systematic review with eligibility inclusion and exclusion criteria decided in advance. Keywords and their synonyms were combined and then used to search health and social care databases. Data items were collected from the included studies. The preferred reporting item for systematic reviews and meta-analysis was followed for the reporting of the results. A narrative synthesis approach was applied to the analysis. Findings A total of 34 full text studies were downloaded, read and analysed. In all, 11 met the inclusion criteria and were included in the final analysis. Of these, three studies reported sensitivity and specificity, with the remainder reporting validity and reliability testing. In total, 12 tools of varying length and quality were found. The length and characteristics of tools affects the efficacy of their use. The clinical environment will determine choice of screening tool to be used. Screening tools should be used within an overall system of detection and management of abuse. Research limitations/implications The synthesis of results was challenging due to the lack of homogeneity between the included studies. The variations in tool characteristics and qualities added to this challenge. A further limitation was the lack of a gold standard tool in elder abuse. Originality/value This systematic review highlights a lack of robust evidence in the development and validation of screening tools to detect elder abuse. Though there is an increasing awareness and knowledge about elder abuse, its detection remains problematic and the lack of research in this area is worth emphasising. Specific tools, centred on the clinical setting in which they are used, are recommended.

scholarly journals Assessments of mental capacity: upholding the rights of the vulnerable or the misleading comfort of pseudo objectivity?

2019 ◽  
Vol 21 (2) ◽  
pp. 74-84 ◽  
Author(s):  
Jim Rogers ◽  
Lucy Bright
Keyword(s):  
Good Practice ◽  
Study Participant ◽  
Mental Capacity ◽  
Self Report ◽  
Assessment Process ◽  
Functional Requirements ◽  
Content Type ◽  
Health And Social Care ◽  
Mental Capacity Act ◽  
The Uk

PurposeThe purpose of this paper is to present findings from a research project which investigated the approaches of different groups of assessors to the mental capacity assessments which are required to be conducted as part of Deprivation of Liberty Safeguards (DOLS).Design/methodology/approachFour case study vignettes were given to participants. Three groups involved in the DOLS assessment process were interviewed by telephone about the factors that may influence their capacity assessments.FindingsMost assessors did not refer to the required two-stage test of capacity or the “causative nexus” which requires that assessors must make clear that it is the identified “diagnostic” element which is leading to the inability to meet the “functional” requirements of the capacity test. The normative element of capacity assessments is acknowledged by a number of assessors who suggest that judging a person’s ability to “weigh” information, in particular, is a subjective and value-based exercise, which is given pseudo objectivity by the language of the Mental Capacity Act (MCA). A number of elements of good practice were also identified.Research limitations/implicationsIn this exploratory study, participant numbers were small (n=21), and the authors relied on self-report rather than actual observations of practice or audit of completed assessments.Practical implicationsThe findings are of relevance to all of those working in health and social care who undertake assessments of mental capacity, and will be helpful to all of those tasked with designing and delivering training in relation to the MCA 2005. They also have relevance to policy makers in the UK who are involved with reforms to DOLS regulations, and to those in other countries which have legislation similar to the MCA.Originality/valueMuch existing literature exhorts further training around the MCA. The authors suggest that an equally important task is for practitioners to understand and be explicit about the normative elements of the process, and the place of ethics and values alongside the more cognitive and procedural aspects of capacity assessments.

Community business impacts on health and well-being: a systematic review of the evidence

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stuart McClean ◽  
Sanda Ismail ◽  
Emma Bird
Keyword(s):  
Systematic Review ◽  
Local Community ◽  
Social Care ◽  
Well Being ◽  
Positive Contribution ◽  
Systematic Review Methodology ◽  
Content Type ◽  
Health And Social Care ◽  
The Impact ◽  
Health And Well Being

Purpose This paper aims to provide critical insight into the impact of locally embedded, community business-related approaches internationally to health and social care on users’ outcomes, in particular exploring their effectiveness in delivering outcomes for users. Design/methodology/approach The study used a robust systematic review methodology. It carefully identifies relevant studies that have been conducted on the impact of community business-related approaches, rigorously evaluates how well these studies have been carried out and combines the results from these studies to address that particular topic. Findings Health and social care-related community businesses deliver on a range of health and well-being outcomes and impacts positively on local residents’ satisfaction with their community/local area. Existing research into community businesses uses mostly qualitative methods, but a few studies have also used quantitative survey and mixed methods and demonstrate the challenges of conducting methodologically rigorous real-world research within local community settings. Research limitations/implications The review was limited to papers published in English language and may have missed relevant studies published in other languages which could have influenced the overall findings. Only one reviewer screened the titles and abstracts of the identified papers. Having multiple reviewers would have strengthened the validity of the screening process. Originality/value Community businesses offer a positive contribution to health and well-being, and highlight the significance of engaging local communities in promoting health, reducing health inequalities and addressing the wider determinants of health. This paper provides a baseline of evidence about community business’ broad impacts on health and well-being to help inform new and emerging evidence

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