Case studies

All these case scenarios have been reproduced from the Mental Capacity Act 2005 Code of Practice and Making Decisions – A guide for people who work in health and social care (OPG 603). Both of these are available to download for free from the Office of the Public Guardian’s website.

Scenario 10C: Providing relevant information in an appropriate format

Mr Leslie has learning disabilities and has developed an irregular heartbeat. He has been prescribed medication for this, but is anxious about having regular blood tests to check his medication levels. His doctor gives him a leaflet to explain: the reason for the tests what a blood test involves the risks in having or not having the tests, and that he has the right to decide whether or not to have the test. 

The leaflet uses simple language and photographs to explain these things. Mr Leslie's carer helps him read the leaflet over the next few days, and checks that he understands it. Mr Leslie goes back to tell the doctor that, even though he is scared of needles, he will agree to the blood tests so that he can get the right medication.

He is able to pick out the equipment needed to do the blood test. So the doctor concludes that Mr Leslie can understand, retain and use the relevant information and therefore has the capacity to make the decision to have the test.

Scenario 11A: Giving appropriate advice and support

Sara, a young woman with severe depression, is getting treatment from mental health services. Her psychiatrist determines that she has capacity to make decisions about treatment, if she gets advice and support.

Her mother is trying to persuade Sara to agree to electro-convulsive therapy (ECT), which helped her mother when she had clinical depression in the past. However, a friend has told Sara that ECT is ‘barbaric'. The psychiatrist provides factual information about the different types of treatment available and explains their advantages and disadvantages. She also describes how different people experience different reactions or side effects.

Sara is then able to consider what treatment is right for her, based on factual information rather than the personal opinions of her mother and friend.

Scenario 11B: Providing relevant information

Mrs Thomas has Alzheimer's disease and lives in a care home. She enjoys taking part in the activities provided at the home. Today there is a choice between going to a flower show, attending her usual pottery class or watching a DVD.

Although she has the capacity to choose, having to decide is making her anxious. The care assistant carefully explains the different options. She tells Mrs Thomas about the DVD she could watch, but Mrs Thomas doesn't like the sound of it. The care assistant shows her a leaflet about the flower show. She explains the plans for the day, where the show is being held and how long it will take to get there in the mini-van.

She has to repeat this information several times, as Mrs Thomas keeps asking whether they will be back in time for supper. She also tells Mrs Thomas that one of her friends is going on the trip. At first, Mrs Thomas is reluctant to disturb her usual routine. But the care assistant reassures her she will not lose her place at pottery if she misses a class. With this information, Mrs Thomas can therefore choose whether or not to go on the day trip.

Scenario 12: Getting the location and timing right

Luke, a young man, was seriously injured in a road traffic accident and suffered permanent brain damage. He has been in hospital several months, and has made good progress, but he gets very frustrated at his inability to concentrate or do things for himself. Luke now needs surgical treatment on his leg.

During the early morning ward round, the surgeon tries to explain what is involved in the operation. She asks Luke to sign a consent form, but he gets angry and says he doesn't want to talk about it. His key nurse knows that Luke becomes more alert and capable later in the day.

After lunch, she asks him if he would like to discuss the operation again. She also knows that he responds better one-to-one than in a group. So she takes Luke into a private room and repeats the information that the surgeon gave him earlier. He understands why the treatment is needed, what is involved and the likely consequences. Therefore, Luke has the capacity to make a decision about the operation.

Scenario 13: Getting help from other people

Jane has a learning disability. She expresses herself using some words, facial expressions and body language. She has lived in her current community home all her life, but now needs to move to a new group home.

She finds it difficult to discuss abstract ideas or things she hasn't experienced. Staff conclude that she lacks the capacity to decide for herself which new group home she should move to. The staff involve an advocate to help Jane express her views.

Jane's advocate spends time with her in different environments. The advocate uses pictures, symbols and Makaton to find out the things that are important to Jane, and speaks to people who know Jane to find out what they think she likes. She then supports Jane to show their work to her care manager, and checks that the new homes suggested for her are able to meet Jane's needs and preferences.

When the care manager has found some suitable places, Jane's advocate visits the homes with Jane. They take photos of the houses to help her distinguish between them. The advocate then uses the photos to help Jane work out which home she prefers. Jane's own feelings can now play an important part in deciding what is in her best interests – and so in the final decision about where she will live.