A Delphi survey of practitioner’s understanding of mental capacity
| Pages | 174-186 |
| Published date | 10 December 2018 |
| DOI | https://doi.org/10.1108/JAP-05-2018-0009 |
| Date | 10 December 2018 |
| Author | George Clerk,Jason Schaub,David Hancock,Colin Martin |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection,Safeguarding,Sociology,Sociology of the family,Abuse |
A Delphi survey of practitioner’s
understanding of mental capacity
George Clerk, Jason Schaub, David Hancock and Colin Martin
Abstract
Purpose –The purpose of this paper is to present the findings of a study considering the application of the
Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Practitioners froma range of professions
were recruited to provide their views of how to respond to a variety of scenarios. GPs, nurses, social workers,
physio/occupational therapists and care assistants were recruited to participate.
Design/methodology/approach –This study used the Delphi method to elicit participant views and
generate consensus of opinion. The Delphi method recommends a large sample for heterogeneous groups,
and round one had 98 participants from six different professional groups.
Findings –Participants did not respond consistently to the scenarios, but disagreed most significantly when
patient decisions conflicted with clinical advice, and when to conduct a capacity assessment. These
responses suggest that clinical responses vary significantly between individuals (even within settings or
professions), and that the application of Mental Capacity Act (MCA) is complicated and nuanced, requiring
time for reflection to avoid paternalistic clinical interventions.
Originality/value –Previous studies have not used a Delphi method to consider the application of
MCA/DoLS. Because of this methods focus on developing consensus, it is uniquely suited to considering this
practice issue. As a result, these findings present more developed understanding of the complexity and
challenges for practitioner responses to some relatively common clinical scenarios, suggesting the need for
greater clarity for practitioners.
Keywords Consensus, Legislation, Deprivation of liberty, Mental capacity, Best interest, Professional capacity
Paper type Research paper
Context
The Mental Capacity Act (MCA) 2005 sought to provide a framework for decision making by
health and social care providers and professionals, relating to adults who may not have the
capacity to make decisions for themselves. Prior to its implementation, there was insufficient
legal guidance in situations requiring self-determination; for example, an adult lacking capacity as
a result of dementia who is unable to make decisions regarding her care. Although previous
decision making was guided by common law, practice in health and social care was largely
influenced by a paternalistic culture that reduced the agency of patients (Samuel, 2014). In an
attempt to protect individuals and provide a clear legal framework to guide practice, the Law
Commission initiated a process that culminated in the MCA.
Outline of the MCA
The MCA applies to people over the age of 16 in England and Wales where there are concerns
about a person’s decision making ability. It is underpinned by five enduring principles of care,
seeking to place the individual at the heart of decision making. These five principles are: the
presumption of capacity; supporting individuals to make decisions; the right to make an “unwise
decision”; the “best interest principle”; and the “least restriction principle”. Section two of the
MCA requires professionals to presume that a person has capacity unless there is reason to
believe otherwise. The legal presumption in favour of capacity is based on functional terms,
Received 10 May 2018
Revised 27 September 2018
Accepted 1 October 2018
George Clerk is Lecturer in
Criminology at the
Buckinghamshire New
University, Wycombe, UK.
Jason Schaub is based at the
University of Birmingham,
Birmingham, UK.
David Hancock is based at the
Buckinghamshire New
University, Wycombe, UK.
Colin Martin is based at the
University of Hull, Hull, UK.
PAGE174
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THE JOURNAL OF ADULT PROTECTION
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VOL. 20 NO. 5/6 2018, pp. 174-186, © Emerald Publishing Limited, ISSN 1466-8203 DOI 10.1108/JAP-05-2018-0009
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