I just have a question regarding MCA. I see a lot of instances in which a patient is conveyed to A&E by both, Police and ambulance staff.
When patients are brought in, they say that the patient is under MCA. In some cases, LAS are in agreement that the patient lacks capacity (even though, patients are clearly mentally unwell, and there is not a physical impairment that makes them lack capacity, but my understanding of MCA/MHA can be another question). In some cases, it sounds like the Police are the ones making this decision, with LAS either not agreeing or maybe stating that they have been unable to appropriately assess capacity, and therefore it has been the police who have documented their Section 5 paperwork.
My question is: is this okay? My understanding is that it should be LAS who are meant to document capacity as they are the closest health professional on scene.
Secondly, in one instance, a patient was brought cuffed and Police documented on their Section paperwork: when responding to the question of âdoes the patient have a physical or mental impairmentâŚâ, they wrote: ânot trained to perform this assessmentâ - but despite that, went ahead and wrote that the patient did not have capacity and was brought with cuffs. Is this okay?
Probably a typical issue with MCA. the police and ambulance are both able to use the MCA to protect individuals from harm and could be accused of negligence if they fail to do so. But the police donât tend to be well trained as such and will say they donât have expertise in the MCA. So documentation will often be poor.
If the police officer âreasonably believesâ the person has some impairment of their mind or brain (which can include inebriation or acute anxiety) and cannot make a decision, then they can determine the person lacks capacity to make the decision. In the police context, the person is likely to be at some form of immediate risk.
Separately there will be issues around the police use of the MCA for people in a mental health crisis (as opposed to a physical cause) for whom the MHA section 136 is likely to be the more appropriate and lawful response.
Thank you for your comments. I was feeling very uneased about this interaction, but I guess they were just trying to make the safest thing and bring the person to the most appropriate place and safeguard them from harm.
There were doubts also about if someone in extreme distress/anxiety could be deemed as lacking capacity, if they were answering appropriately all the questions during assessment. It was my understanding that if someone is emotionally disturbed, they can lack capacity to appropriately weight decisions and therefore could be treated or kept in safe place under MCA; but some colleagues seemed to think that is your answers to the questions of MCA are appropriate, then you do not lack capacity but rather you are making an unwise decision. Is this correct? Can you deemed someone as lacking capacity if they seem emotionally disturbed? Or should that decision come from a MHA?
Firstly there can be only one decision maker, not plural ie. Police person in this case. Next what is the question is that is being asked of the patient/service user/client/member of public. This needs to be documented.
Can this person, understand, retain, weigh and communicate their decision. If they can, then the decision maker stops there. Contrary to belief, one does not go on to state that the person is making an unwise decision or a best interest decision needs to be made. If they are deemed to be lacking capacity as to impairment of mind or brain, then you continue.
The question then arises why are they going to hospital for, or what is one attempting to do as an end objective in going to hospital.
Whatever the decision maker does, needs to document this fully. More often than not, decision makers fail to write down what did the assessed person said or did; if they cannot understand by virtue of language or disability, how were they assisted?