Approaches to the mental capacity assessment of people experiencing multiple exclusion homelessness in England: A scoping paper

TY - BOOK

T1 - Approaches to the mental capacity assessment of people experiencing multiple exclusion homelessness in England

T2 - A scoping paper

AU - Martineau, Stephen

PY - 2025/3/6

Y1 - 2025/3/6

N2 - This paper presents findings from interviews with 10 experts conducted in 2023, which focused on the assessment of the mental capacity of people with experience of multiple exclusion homelessness (MEH)* in England. Funded by the NIHR School for Social Care Research, the study’s purpose was to scope this topic in advance of a larger 30-month research study (2023-26). Participants were: two third sector workers, a social worker, a GP, a nurse, a psychiatrist, a psychologist, a lawyer, an expert in brain injury, and an academic.**The Findings are presented in three sections. The first – Conducting assessments – broadly reflects these experts’ own experience when it comes to the basic components of capacity assessment with this population: who assesses, which decisions, what practicable steps, what impairments, and so forth. It also includes findings on emergency scenarios and working with the Mental Health Act 1983 (MHA). The second section – Broader considerations – is dedicated to the responses to three questions. The first of these, about the significance of the assessor’s values in capacity assessment, was asked in light of the association of MEH with social justice concerns; also relevant was the recent work of Kong on values among legal professionals working with the Mental Capacity Act 2005 (MCA) and the discussion by Series about ‘empowerment entrepreneurs’ and the 2005 Act. Next, a question was asked about the significance of ethnicity in light of the lack of research evidence in relation to the MCA (in contrast to the MHA). Towards the end of the interview, participants were asked what a ‘good’ assessment with this client group would include (thinking beyond statutory requirements); the prompt to do this was our ambition in the larger follow-up 2023-26 study to produce operational guidance for practitioners working with this group.Finally, the Critical reflections section draws together themes from these semi-structured interviews, where participants developed their thoughts on problematic aspects of current practice. Sub-headings here are: Capacity assessments are often hard to do; Contested assessments; Contextual factors and assessment; Ethical concerns; Stigma and discrimination; ‘Bad decisions’, ‘bad options’, and agency.The paper ends with a Commentary in four parts: 1. Practicalities and the support principle; 2. Conducting and recording assessments; 3. Skills and contexts; 4. Agency.The author would welcome any comments on this paper: [email protected]* Multiple exclusion homelessness (MEH) is a term used to capture the phenomenon of homelessness where it occurs along with other experiences associated with social exclusion. These might include adverse childhood experiences, institutional care (for example, as a result of detention under the Mental Health Act 1983), substance use and ‘street culture’ activities (such as begging and street drinking). Use of the term directs attention toward the health and social care needs of this population.** The small scale of this study precluded the inclusion of people with experience of MEH in the interview cohort, since this would have entailed a more involved ethical approvals process than resources allowed. The 2023-26 study involves people with lived experience of MEH in an advisory and oversight capacity, and in its fieldwork.

AB - This paper presents findings from interviews with 10 experts conducted in 2023, which focused on the assessment of the mental capacity of people with experience of multiple exclusion homelessness (MEH)* in England. Funded by the NIHR School for Social Care Research, the study’s purpose was to scope this topic in advance of a larger 30-month research study (2023-26). Participants were: two third sector workers, a social worker, a GP, a nurse, a psychiatrist, a psychologist, a lawyer, an expert in brain injury, and an academic.**The Findings are presented in three sections. The first – Conducting assessments – broadly reflects these experts’ own experience when it comes to the basic components of capacity assessment with this population: who assesses, which decisions, what practicable steps, what impairments, and so forth. It also includes findings on emergency scenarios and working with the Mental Health Act 1983 (MHA). The second section – Broader considerations – is dedicated to the responses to three questions. The first of these, about the significance of the assessor’s values in capacity assessment, was asked in light of the association of MEH with social justice concerns; also relevant was the recent work of Kong on values among legal professionals working with the Mental Capacity Act 2005 (MCA) and the discussion by Series about ‘empowerment entrepreneurs’ and the 2005 Act. Next, a question was asked about the significance of ethnicity in light of the lack of research evidence in relation to the MCA (in contrast to the MHA). Towards the end of the interview, participants were asked what a ‘good’ assessment with this client group would include (thinking beyond statutory requirements); the prompt to do this was our ambition in the larger follow-up 2023-26 study to produce operational guidance for practitioners working with this group.Finally, the Critical reflections section draws together themes from these semi-structured interviews, where participants developed their thoughts on problematic aspects of current practice. Sub-headings here are: Capacity assessments are often hard to do; Contested assessments; Contextual factors and assessment; Ethical concerns; Stigma and discrimination; ‘Bad decisions’, ‘bad options’, and agency.The paper ends with a Commentary in four parts: 1. Practicalities and the support principle; 2. Conducting and recording assessments; 3. Skills and contexts; 4. Agency.The author would welcome any comments on this paper: [email protected]* Multiple exclusion homelessness (MEH) is a term used to capture the phenomenon of homelessness where it occurs along with other experiences associated with social exclusion. These might include adverse childhood experiences, institutional care (for example, as a result of detention under the Mental Health Act 1983), substance use and ‘street culture’ activities (such as begging and street drinking). Use of the term directs attention toward the health and social care needs of this population.** The small scale of this study precluded the inclusion of people with experience of MEH in the interview cohort, since this would have entailed a more involved ethical approvals process than resources allowed. The 2023-26 study involves people with lived experience of MEH in an advisory and oversight capacity, and in its fieldwork.

UR - https://www.mentalcapacitylawandpolicy.org.uk/the-mca-and-multiple-exclusion-homelessness-a-scoping-paper-walkthrough/

UR - https://www.kcl.ac.uk/news/capacity-assessment-and-meh

UR - https://www.kcl.ac.uk/research/mca-meh

UR - https://www.kcl.ac.uk/research/mca-homelessness

UR - https://www.kcl.ac.uk/research/homelessness-research-programme

UR - https://www.kcl.ac.uk/events/series/homelessness-series

U2 - 10.18742/pub01-205

DO - 10.18742/pub01-205

M3 - Report

BT - Approaches to the mental capacity assessment of people experiencing multiple exclusion homelessness in England

PB - NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London

CY - London

ER -