Doing it Right: The Mental Capacity Assessment Journey

There is a famous saying, “Quality, not quantity is my measure” and this pretty much sums up TSF’s ethos.

Achieving the highest quality capacity assessments is at the heart of what we do – we pride ourselves on adhering to a rigorous process from referral and gathering of essential pre-assessment information, through to the completion of robust post-assessment reports. And this means that we will turn around an assessment as quickly as possible, but not so quick as to compromise on quality. When all is said and done, the decisions we make could and do fundamentally change the course of our client’s lives, and so we must take the time to ensure we have got it right.

Preparation is Key

As Benjamin Franklin famously said, “By failing to prepare, you are preparing to fail”. Ask any master craftsman and they will tell you that you should spend the majority of your time in the preparation of a project, and only if you do this will you be satisfied with the end result. This is the view we take when it comes to assessing.

TSF have developed a range of unique processes that enable us to identify the threshold of understanding and associated question set for every decision we assess. This starts with an effective referral process and being clear about the decision that the client is being asked to make. The more accurate and specific the question being asked, the more likely you are to reach the right outcome. Our team of dedicated Client Liaison Officers guide clients through each case, from start to finish, ensuring that the initial referral stage gathers all the salient information. We are acutely aware that the assessment process can appear confusing, and we endeavour to make the process as simple as possible.

This pre-assessment stage is crucial as identifying the right decision also enables the identification of the correct test to use – MCA and/or additional case law. Once the question being asked has been determined, it is then vital to gather as much relevant information as possible. The amount of information needed will depend on the complexity of the decision being addressed and should be gathered from as many independent sources as possible, for example family members, carers, GP records etc. It goes without saying that these sources should be free from any undue influence and we need to be aware of any conflict of interest that any third-party information may contain.

All of this evidence is essential when determining if the client has a ‘frontal lobe paradox’ –in other words, someone does not act in a way that matches the things they say. Without it, we would not be able to build up a true picture of the situation.

Our aim is to tailor the assessment to the client as much as possible and meet their needs with knowledge and empathy. So, the more we know, the more we can support them during the assessment. Turning back to the craftsman metaphor, no one wants them turning up to the job only to discover they don’t have the right tools for it.

This evidence gathering process takes time, hence we NEVER rush through any assessment. Doing so can risk the integrity of the post-assessment report and face possible rejection from the Courts, and the consequent unnecessary delays and stress – as the old adage goes, “More haste, less speed”.

We have spent more than 10 years fine-tuning this referral process to get it as smooth and efficient as we can so we can achieve the best assessment for our clients.

Evaluate and consolidate

Post assessment is another crucial stage in our process and this requires a whole new set of skills from our assessors as they review their evidence, corroborate information, consider any relevant case law and then put all this into our ‘gold standard’ report that will stand up to possible challenge.

We pride ourselves on our own unique Quality Monitoring Team whose sole purpose is to uphold this ‘gold standard’, ensuring our assessments and outcomes are of the highest quality, and produce some of the most robust reports in the industry which stand up to legal challenge. They work closely with our assessors and stay abreast of what’s happening in the Courts and the larger field of mental capacity.

We want it done right first time, so the more care we take during this stage to strengthen our assessments and reports, the more time it saves the client in the long run. We understand the emotional and mental strain it can take on the client and their families, so we commit this time to ensure they can rely on our reports.

In the vast majority of cases, we will be able to give the outcome of the assessment on the same day. However, the reality is that people are complex and do not fit into one box, so for the minority of those borderline cases, re-visits may be required or additional fact checking needed before we can come down on one side or the other. (For clarity, the cases we are talking of here are where this would be supported under the MCA, not simply assessor error).

In this modern world of immediate gratification, acknowledging that something takes time is not always an easy thing to do. However, we value our integrity and would rather be honest with our clients when we know certain cases need further consideration.

By giving our assessors time to analyse all the evidence and reflect on their practice, we ensure they are able to stand behind each and every decision 100%. We think our clients deserve that.

Our clients are not just another assessment to speed through with little thought or care. They are individuals with a history and a future still awaiting them. We want to take the opportunity to hear them, to see them and to recognise the gravity of the situations they face.

Quality is not something we say flippantly to make us sound good. We live and breathe it and are willing to put our neck on the line to prove it.