The Mental Capacity Act 2005: A Complete Guide for Care Providers

The second principle requires that a person should be supported to make a decision before any conclusion is reached that they lack capacity. This principle recognises that many people can make decisions with the right support. Support might include providing information in an accessible format, allowing extra time, using visual aids, removing distractions, or involving a trusted family member.

This principle is particularly important in care settings. Before concluding that someone lacks capacity, you must have done everything practicable to help them make the decision themselves. This often requires creativity and empathy; for example, visiting a care plan review at the time of day when the person is most alert, or providing a written summary of the proposed changes before the meeting.

The first principle states that a person must be assumed to have capacity unless it is established that they lack capacity. This is a fundamental shift from older approaches that assumed vulnerability. The presumption of capacity places the burden of proof on those who question it. In practice, this means you must never assume someone cannot make a decision simply because they have a diagnosis, disability, or appear to struggle.

For care providers, this means starting from the position that the person can make the decision. You should only assess capacity formally if there is a genuine question about whether the person can understand, retain, use, or communicate the information relevant to that specific decision

The fourth principle requires that any action taken or decision made on behalf of someone who lacks capacity must be in their best interests. This is a core principle of the Act. When you are making a decision on behalf of someone without capacity, you must follow a specific process to determine what is in their best interests, rather than what is convenient for the service or what you think the person should do.

The fifth principle states that when a decision is made on behalf of someone without capacity, this should be done in a way that is less restrictive of their rights and freedoms as possible. This principle ensures that even when you are acting in someone's best interests, you consider less restrictive alternatives and choose the option that interferes least with their autonomy and rights.

For example, if a person lacks capacity to make decisions about financial matters, you would consider a third-party mandate or limited power of attorney before proposing full deprivation of liberty safeguards. The goal is to enable as much autonomy as possible whilst protecting the person.