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Experiences of assessing mental capacity in England and Wales: A large-scale survey of professionals

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Article number144
Pages (from-to)1-17
JournalWellcome Open Research
Published10 Jun 2021

Bibliographical note

Funding Information: We are grateful to the British Psychological Society (BPS) and the British Neuropsychiatry Association (BNPA) for their permission to distribute the survey at their events. We are also grateful to Steve Fleming for commenting on early drafts of the survey, and to Alex Ruck Keene and Isabel Clare for their support with recruiting participants online. Publisher Copyright: © 2021 Ariyo K et al. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Background: The Mental Capacity Act (2005) of England and Wales described in statute a test to determine whether a person lacked the "mental capacity" to make a particular decision. No large-scale survey has explored experiences of capacity assessment across professional groups. Methods: We administered an opportunistic self-report questionnaire survey of professionals who undertake capacity assessments in England and Wales (n= 611). Topics of interest included; how often and where capacity assessment took place, self-ratings of competency and challenges experienced in assessment, use of psychological testing and concerns about undue influence. We analysed the quantitative responses using a mixed-methods approach using regression methods for the quantitative ratings and a thematic analysis for qualitative data. Results: Our sample included 307/611 (50.2%), social workers, 89/611 (14.6%) psychiatrists, 62/611 (10.1%) nurses, 46/611 (7.5%) clinical psychologists, 30/611 (4.9%) doctors from other medical specialties, 12/611 (2.0%) speech and language therapists and 8/611 (1.3%) solicitors. 53% of these professionals undertook more than 25 capacity assessments per year, with psychiatrists, social workers and nurses undertaking them the most frequently. Most professionals reported high self-ratings of confidence in their assessment skills, although non-psychiatrist doctors rated themselves significantly lower than other groups (p< .005). Most professionals (77.1%) were at least moderately concerned about undue influence, with people with dementia and learning disabilities and older adults considered to be the most at risk. Qualitative themes for challenges in capacity assessment included inter-disciplinary working, complicated presentations and relational issues such as interpersonal influence. Requests for support mainly focused on practical issues. Conclusions: Most professionals feel confident in their ability to assess capacity but note substantial challenges around practical and relational issues. Undue influence is a particularly common concern amongst professionals when working with service users with dementia and learning disabilities which public services and policy makers need to be mindful of.

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