There is a new law that can help - The Mental Capacity Act 2005
Making decisions
...about your health, welfare or finance.
Who decides when you can’t?
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Making decisions
...about your health, welfare or finance.
Who decides when you can’t?
Helping people who are unable to make
some decisions for themselves
This booklet provides introductory information on the Mental Capacity Act 2005 and how it
will affect you. It is not a statutory Code of Practice issued under the Mental Capacity Act
2005 and is not a guide to how the law will apply to specific situations.
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This document has been produced by:
In association with the Making Decisions Alliance, including:
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Acknowledgements
The Mental Capacity Implementation Programme (MCIP) published
this booklet. MCIP is a joint government programme between the
Department for Constitutional Affairs, the Department of Health, the
Public Guardianship Office and the Welsh Assembly Government
that has been established to implement the organisation, process
and procedures to launch the Mental Capacity Act in 2007.
We are very grateful to the team from the Making Decisions Alliance
who wrote this booklet. In particular, Ayesha Janjua, Senior Policy
Advisor at Turning Point who wrote this booklet with support from
Richard Kramer, Director of Policy at Turning Point, Wendy Banks
and Vicki Hornby from Scope and Keith Dawson from Mind. We
would also like to thank service users from Scope and from Mind
for their comments on this booklet.
We are also very grateful to our Advisory Group which was made up
of organisations who work with or represent people who may lack
the capacity to make some decisions for themselves. They played an
important role in sharing their views and perspectives on the booklet
and helped us to reflect on our work.
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Contents
1 Introduction 6
About this booklet 6
Summary of the key points 7
2 What is the Mental Capacity Act and how could it affect me? 8
What does ‘mental capacity’ mean? 8
Why do we need a Mental Capacity Act? 9
When does the Mental Capacity Act start to work? 10
The Principles of the Act 11
3 When would someone assess my capacity to make a decision? 13
Who decides whether or not I lack capacity? 14
How would someone decide whether or not I lack capacity? 15
4 What happens if I am unable to make my own decisions? 16
How does someone work out what would be in my best interests? 16
Providing care or treatment for you if you lack capacity 18
The use of restraint 18
Protecting people from ill-treatment or wilful neglect 18
5 What if I want to plan ahead in case I lack capacity in the future? 19
Lasting Power of Attorney 19
How do I make a Lasting Power of Attorney? 20
What if I already have an Enduring Power of Attorney? 21
Making an advance decision to refuse treatment 22
Making advance decisions about life sustaining treatment 23
What if I already have an advance decision (or ‘living will’)? 24
Will this change the law on euthanasia or assisted suicide? 25
Advance decisions and the Mental Health Act 1983 25
Recording your wishes and feelings about treatment and care 26
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6 What further support is available? 27
Support from family and friends 27
Support from an advocate 27
Support if you do not have any family or friends 27
7 What will happen if I have not planned ahead? 30
8 Challenging decisions and raising concerns 31
9 What does the Act say about research? 33
10 How the new law is being supported 35
Code of Practice 35
Court of Protection 35
Deputies 35
What if I already have a receiver? 37
Office of the Public Guardian 38
11 What if I want to know more about the MCA? 39
12 Some useful contacts 40
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1. Introduction
About this booklet
This booklet gives you information about a new law, the Mental
Capacity Act 2005, which comes into force during 2007, and which
will affect anyone who is unable to make some or all decisions. The
inability to make a decision could be because of a learning disability,
mental health problems, brain injury, dementia, alcohol or drug misuse,
side effects of medical treatment or any other illness or disability.
The new law will help and support you if:
you currently find it difficult to make decisions sometimes or all
of the time
you want to plan ahead in case you are unable to make
decisions in the future.
This booklet explains:
how the Mental Capacity Act could affect you
how you can plan ahead now in case you cannot make your
own decisions in the future
how you will be protected if you are unable to make a decision
either now or anytime in the future
on what basis other people can take actions on your behalf if
you cannot do so
where to go for help and advice.
Another key source of information and more detailed guidance is the
Code of Practice that accompanies the Act. It can be found online at
www.dca.gov.uk/legal-policy/mental-capacity/publications.htm
This booklet is not about detention or compulsory treatment under
the Mental Health Act 1983. The 1983 Act is primarily about people
who are diagnosed as having a mental health problem which
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requires that they be detained or treated in the interests of their own
health or safety or with a view to protecting other people.
The information in this booklet relates only to England and Wales
and mainly to people over the age of 16.
Summary of the key points in this booklet:
The new law protects your right to make your own decisions
and to be involved in any decisions that affect you.
There are a number of ways that you can plan ahead and set out
in advance what you would like to happen should you be unable to
make your own decision in the future (see part 5 of this booklet).
If you are unable to make your own decision about something
that affects you and if you have not planned ahead, other
people will make decisions or take actions on your behalf in
your best interests (see part 4 of this booklet).
For most day-to-day actions or decisions, your family or carer
will assess your capacity to make the particular decision. For
more complex decisions, a more formal assessment may
require the involvement of different people such as a doctor or
other professionals (see part 3).
When a decision is being made on your behalf, it must be in your
best interests and the people who care for you or your friends
and family must be consulted where practical and appropriate
and their views must be taken into account (see part 4).
If you do not have capacity to make a particular decision
and you do not have any friends or family, for certain serious
decisions such as serious medical treatment or moving into
long-term care or a hospital, you will get extra support from an
Independent Mental Capacity Advocate (IMCA) (see part 6).
The Act provides a clear legal framework for dealing with mental
capacity issues and will help to ensure that fraud and abuse do
not take place.
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2. What is the Mental Capacity Act and
how could it affect me?
What does ‘mental capacity’ mean?
If you have mental capacity, you are able to make decisions for
yourself. The legal definition says that someone who lacks capacity
cannot do one or more of the following four things:
Understand information given to them.
Retain that information long enough to be able to make a
decision.
Weigh up the information available to make a decision.
Communicate their decision. This could be by any possible
means, such as talking, using sign language or even simple
muscle movements such as blinking an eye or squeezing a hand.
The types of decision that are covered by the Act range from
day-to-day decisions about things such as what to wear or eat,
through to serious decisions such as where you live, deciding if you
need to have an operation or what to do with your money and property.
However, some types of decisions (such as marriage or civil
partnership, divorce, sexual relationships, adoption and voting)
can never be made by another person on your behalf if you lack
capacity and the Mental Capacity Act does not change this. This
is because these decisions or actions are either so personal to the
individual or because other laws govern them.
The Mental Capacity Act applies to situations where you may
be unable to make a particular decision at a particular time, to
the extent that you cannot do one or more of the points above.
For example, someone with dementia may be unable to retain
information long enough in order to make decisions. Or someone
with a mental health problem may feel too depressed to make a
decision that he or she is able to make when feeling less depressed.
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In both these instances it may be the case that the person lacks
capacity to make particular decisions at particular times.
This does not necessarily mean that a person lacks all capacity to
make any decisions at all. A person with a learning disability may lack
the capacity to make complex decisions but this does not necessarily
mean that they cannot decide what to eat, wear and do each day.
Why do we need a Mental Capacity Act?
The Mental Capacity Act provides a clearer legal basis for making
decisions and in doing so promotes best practice in supporting
people who may lack mental capacity.
The Mental Capacity Act sets out in law what happens when people
are unable to make decisions, i.e. when they lack capacity to make
a particular decision. The Act provides protection and support
should you find yourself in any of these situations.
The Act is there to:
strengthen the right of people to make their own decisions and
to be supported to do so
protect those who may lack capacity to make a particular
decision
set out in which situations other people can make decisions
and act on your behalf if you are unable to do so
ensure you are to be involved in decisions that affect you
help resolve disputes.
The Act is accompanied by a Code of Practice that provides more
in-depth guidance. All professionals, such as GPs, doctors, social
workers, and paid carers, must have regard to the guidance in
the Code of Practice when they are supporting anyone who lacks
capacity. This applies in all health and social care settings, including
GP and hospital appointments, social care assessments and care
review meetings.
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When does the Mental Capacity Act start to work?
There are two distinct phases: April and October 2007.
April 2007
The new Independent Mental Capacity Advocate service
(IMCAs) will become operational in England only (see part 7).
The new criminal offence of ill-treatment or wilful neglect in
England and Wales will come into force (see part 14).
Sections 1-4 of the Act (the principles, assessing capacity
and determining best interests - see parts 4-6) which are
essential to how IMCAs operate will also come into force but
only in situations where an IMCA could be involved, and for the
purposes of the criminal offence. Sections 1-4 of the Act will
not apply in any other situations until October 2007.
The Code of Practice for the Act will be published and should
be followed by those who must have regard to it in situations
where an IMCA could be involved.
October 2007
All other parts of the Act come into force including IMCAs in
Wales.
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The Principles of the Act
There are five key rules or principles that have to be followed by
anyone who is supporting or working with a person who may lack
capacity.
1 All adults have the right to make decisions for themselves
unless it is shown that they are unable to make it. This means
that people must not assume that you cannot make a decision
for yourself just because you have a particular medical
condition or disability, or because of your age or appearance.
2 People should be supported as much as possible to make their
own decision before anyone concludes that they cannot make
their own decision. This may be through using different ways of
communicating such as words, pictures or signs and providing
information in different formats, such as tape or easy-to-read.
In some cases an independent advocate may be able to help.
Example:
Isobel is an 18 year old woman with learning difficulties. Isobel
does not use speech to communicate. Isobel’s support worker
communicates with Isobel through using symbols. A smiley face
indicates what Isobel likes and a sad face what Isobel does
not like. Isobel has used this system for several years at her
residential school. Isobel is about to move from the residential
school to a residential home. Her support worker wants to make
sure that Isobel is involved in deciding what home she will move
to. The support worker and Isobel visit different homes and the
care worker takes photographs at all of the homes.
Isobel and the support worker then look at all the pictures. Isobel
places photographs of two of the homes by the smiley face,
showing she likes them, whilst others by a sad face. Isobel and
the support worker do this several times and the care worker
moves the smiley face from one side of the table to the other.
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Each time, Isobel places the two same photographs by the smiley
face and the others by the sad face. The support worker uses this
information to work out that Isobel is able to decide which home
to move to.
3 People are allowed to make a decision that may seem to other
people to be an unwise or strange decision and a person should
not be treated as unable to make a decision because of this.
Example:
Lucy, who has mental health problems, smokes cigarettes and
continues to do so even though she has a severe chest condition.
Doctors have explained to Lucy the risks if she continues to
smoke and have advised her to give up. She continues to smoke,
against the advice of health professionals.
However, it should not be assumed that Lucy cannot make a
decision about her smoking just because she has decided to do
something that some other people think is unwise or because
they might think that she has made the wrong decision.
4 If a person lacks capacity any decisions or actions taken on
their behalf must be taken in their best interests (unless they
have made a relevant and valid advance decision to refuse
medical treatment - see part 5). It is still important to involve the
person wherever possible in making the decision.
5 The final principle of the Act is to make sure that people who
lack capacity are not restricted unnecessarily. So the person
making the decision or taking the action must consider whether
it is possible to decide or act in a way that would interfere less
with the freedoms and rights of the person who lacks capacity.
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3. When would someone assess my capacity to
make a decision?
The law expects you to be supported as far as possible to make
your own decisions. This could be through providing information in
a more simple way, such as using easier words or pictures, trying at
different times of the day or when you are in better health or having
a friend or an independent person to help you express your choice.
Someone must not make assumptions about your capacity because of
your age or your appearance, such as skin colour or religious dress, or
because of the way you behave or a condition you may have.
It is possible that your ability to make decisions can change.
For instance, a person with dementia may find it harder to make
decisions over time, so that they can no longer make some
decisions that they used to be able to make for themselves.
A person with a learning disability may learn new skills and gain
new understanding so that they are now able to make decisions
they could not make before.
If you have a mental health problem, you may have capacity to
make a particular decision on one day but not the next, and a
decision may need to be delayed until you have regained your
ability to make that decision.
Also, your capacity may depend on the type of decision to be
made. For example, you may be able to make decisions about day
to day things, such as what to eat for dinner and what to wear, but
be unable to make a decision about financial things, like what to do
with your savings.
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Example:
Jermaine was in a rugby accident two years ago and sustained
severe head injuries. Jermaine now has serious memory
problems and has difficulty dealing with money. Jermaine has
received a large financial pay–out from the accident to cover his
care and other needs for the future.
Jermaine lives with his sister and she is concerned that he may
not have the capacity to manage the large amount of money.
Jermaine has said he would like to spend all the money on
managing a rugby team and buying a very expensive car. This
would result in Jermaine having no money left to pay for his care
in the future.
It is agreed that Jermaine lacks the capacity to make serious
financial decisions, but can manage his money on a day-to-
day basis. The Court of Protection is asked to make a suitable
order. The intention is that Jermaine will have an allowance that
he will manage each week and his sister will manage the large
investments for the future.
Who decides whether or not I lack capacity?
The starting point for everyone who may support you on a daily
basis is that they should assume you do have capacity to make the
decision for yourself. They must also follow the principles in the Act
(see part 2).
Anyone - a health or care professional, other professional, relative
or carer - might need to decide if you have the capacity to make a
particular decision. In many everyday cases that decision will be the
responsibility of your family or carers.
Where the decision you face is more complex, the more formal the
assessment of your capacity may need to be and this may involve
doctors or other professionals.
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In medical decisions, where consent is needed for treatment or
examination, the doctor or healthcare professional will decide
whether or not you have capacity to consent. In legal decisions,
such as making a will, the solicitor concerned will decide whether
you have capacity to make that decision. Your family and friends
and any other relevant people should also be consulted during an
assessment but this will depend on the situation and the decision
that needs to be made.
How would someone decide whether or not I lack capacity?
The Act says that before anyone acts on behalf of someone
who lacks capacity, they must have a reasonable belief that the
person lacks capacity. If you lack capacity, actions can be taken
or decisions can be made on your behalf if they are in your best
interests. See part 4 of this booklet for an explanation of best
interests.
The word ‘reasonable’ is important. Capacity can change, and a
person can have capacity to make one decision and not another.
If a person has a constant or degenerative condition however, it
might not be necessary for family or paid carers to make a new
assessment, for example, every morning before helping you
to dress. However you should be supported to make as many
decisions as possible. In that way you may learn new skills and your
capacity may improve over time.
Ultimately, any assessment of capacity will look at the legal
definition of mental capacity which is outlined in part 2.
If you are worried about your ability to make decisions or have
been diagnosed as having a medical condition, such as Alzheimer’s
disease that may affect your ability to make decisions in the future,
your GP should be able to give you more advice. A list of useful
organisations and other sources of information can be found at the
back of this booklet.
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4. What happens if I am unable to make my
own decisions?
The law says that it is important that every reasonable effort has
been made to try to support you to make your own decision.
If you are unable to make a particular decision and you haven’t
made plans about this in advance (see part 5 of this booklet) then
someone else, such as a carer or professional, will have to decide
what should happen. In these circumstances you should still be
involved in the decision-making process as much as possible and
all actions and decisions must be taken in your best interests.
How does someone work out what would be in my
best interests?
Although there is no single definition of what would be in a person’s
best interests, the new Act gives a non-exhaustive checklist of
things that must be considered when another person is making a
decision for you:
Whether the decision can be delayed in case you regain the
ability to make the decision in the future, for example, as a
result of recovering from an episode or illness, learning new
skills, or getting support with communicating your wishes.
The law says that when someone is working out what is in your
best interests, they cannot make a decision based merely on
your appearance, age, medical condition, or behaviour.
When deciding what would be in your best interests all the
relevant information needs to be considered, and it is important
to involve you as much as possible in decisions affecting you.
Your wishes, feelings, values and beliefs. This includes any
views you have expressed in the past that would help to
understand what your wishes and feelings might be. This might
be things you have said to other people, how you have behaved
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in similar circumstances in the past and especially things
you have written down. This places you at the centre of any
decision being made on your behalf.
The views of your family members, parents, carers and other
relevant people who care for you or are interested in your
welfare, if this is practical and appropriate. If you have named
someone particular or given someone powers to decide for you
then they should be consulted.
If decisions are being made about treatment that is needed
to keep you alive, people are not allowed to be motivated by
a desire to bring about your death, and they must not make
assumptions about the quality of your life.
Not all of these checklist factors above will be applicable, but it
is still necessary to consider each of these, even if it is found that
they are not relevant to the particular decision. Anything else that
is relevant must be considered even if it is not included in the
checklist.
Example:
Emma has been very unwell with stomach pains for two months.
She has a learning disability and is scared of hospitals.
The doctor is very concerned about Emma’s health and wants to
do a test that will involve Emma having a tube put down her throat.
The doctor has spoken to Emma’s father, who confirmed that there
is a family history of stomach cancer. The doctor’s starting point
is that Emma has capacity and he needs her consent to treat her.
After discussing the test with Emma, the doctor feels that Emma
does not understand all the pros and cons of the test and therefore
lacks the capacity to give or refuse consent. Taking into account
further discussions with Emma’s family and how ill Emma is, the
doctor decides it is in her best interests that she has the test.
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Providing care or treatment for you if you lack capacity
The Act allows people to legally carry out certain actions to do with
your care or treatment provided that they have assessed that you lack
capacity and that these actions are in your best interests (principle 4).
For example, going into someone’s home without their permission to
clean it for them, or giving someone medication for their condition.
However, where there are several different options available to the
person who is treating you or caring for you, the Act says that they
should use the one which is less restrictive.
The use of restraint
Sometimes it is necessary to physically restrain a person. The Act
allows physical restraint, but only if it is necessary to prevent the
person coming to harm. For example, a carer may prevent you from
stepping out into the middle of a busy road, if you lack capacity to
understand the danger posed by traffic.
However, any restraint has to be reasonable and in proportion
to the potential harm. A carer might prevent you from going out
alone because you cannot cross roads safely, but it would be
unreasonable for them to completely stop you from going outdoors
to protect you from road traffic. If a person uses excessive restraint
they could be liable to a range of civil and criminal penalties.
Protecting people from ill-treatment or wilful neglect
The Act provides a new protection for people who may lack
capacity, to keep them safe and prevent them from being harmed.
This will apply to anyone who works with or supports a person who
lacks capacity to make their own decisions and to attorneys
(see part 5) and deputies (see part 10).
From April 2007 there will be a new criminal offence of ill-treating
or wilfully neglecting a person who lacks capacity. This could cover
restraining someone unreasonably against their will and also the
more commonly understood types of abuse such as financial,
sexual, physical and psychological abuse. The new offence carries a
sentence of up tove years imprisonment and/or ane.
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5. What if I want to plan ahead in case I lack
capacity in the future?
There are several things you can do to prepare for the future, either
by setting out some decisions in advance or by letting people know
what you would like to happen if you lose the capacity to make
decisions. It can also be helpful for your family, future carers, and
for the people you have chosen to make decisions for you, to have
your wishes clearly outlined.
The new Act allows you to appoint someone else to make decisions
for you in the future, should you lack capacity to do this yourself.
At the moment, the law allows you to appoint one or more attorneys
in advance to make decisions about your finances only. From
October 2007, as well as financial matters, you can also plan in
advance and appoint an attorney to make decisions about health
and personal welfare decisions for a time when you might lack
capacity. This is considered below.
Lasting Power of Attorney
A Lasting Power of Attorney (LPA) is a legal form which will allow
you to choose someone else to manage your affairs on your behalf.
The person that you can choose is known as an attorney, and can
be a friend, relative or a professional. You can choose more than
one person to act as an attorney on your behalf.
Your LPA will be specific to you – you decide who will have the
power to control your affairs and the precise limits of that power.
For example, you might want an attorney to make welfare decisions
about your care but not make medical decisions on your behalf.
There are two types of LPAs:
A property and affairs LPA will give powers to your chosen
attorney(s) to make decisions about financial and property
matters for you, such as selling your house or managing your
bank account.
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A personal welfare LPA will give powers to your chosen
attorney(s) make decisions about your health and personal
welfare, such as where you should live, day-to-day care or
having medical treatment.
The difference between these types of LPA is that a personal
welfare LPA will only take effect when you lack capacity to make
decisions. With a property and affairs LPA, you can specify that the
attorney should only start managing you financial affairs after you
lack capacity, sometime in the future. If you do not specify this, the
attorney can start using the LPA after it is registered, but while you
still have capacity.
All attorneys have to have regard to the Code (see part 2) and act in
your best interests (see part 4).
Example:
Jean is in the early stages of Alzheimer’s disease. She appoints
her daughter as a welfare attorney to make any personal welfare
decisions she loses capacity to make. She talks through things
which are important to her such as wanting to stay near her
friends, or to be able to go into a care home that allows pets.
When the LPA is needed, her daughter knows what her mother’s
wishes would be and this helps her act in her mother’s best
interests.
How do I make a Lasting Power of Attorney?
To make an LPA, you will need to complete a form, which you will
be able to get from the Office of the Public Guardian (OPG). An
outline of the role and powers of the OPG can be found in part 10.
There are two forms, one for each type of LPA. If you want to create
two LPAs, one for your property and affairs and another for your
personal welfare, then you will need to complete two separate
forms. Each form will contain guidance to help you fill it in.
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You will be able to make an LPA if you are 18 or over and as long
as you are able to understand what it means. To check this and to
prevent fraud, you will need to provide a certificate, which is part
of the LPA form. The certificate must be signed by an independent
person stating that you fully understand what is involved in making
the LPA, what it will mean to have one in place and that no fraud or
undue pressure is being used to make you create the LPA.
After completing the form and the certificate, the LPA must be
registered with the OPG before it can be used. There will be a fee
for registration. You will also be able to choose who you want to be
notified when the LPA is being registered. This does not have to be
family, it is up to you.
The OPG can be asked to look into what an attorney does, if
someone thinks they might not be acting in a persons best interests.
Any serious problems will be sent to a special court called the Court
of Protection as outlined in part 10. The Court has the power to
remove the attorney if it is found that they have not been acting in
the your best interests.
What if I have already made an Enduring Power of Attorney?
The new system of LPAs is going to replace the existing system of
Enduring Powers of Attorney (EPAs) which currently allows people
to appoint an attorney for property and financial matters. The new
LPAs will give more protection and extra options.
If you have an existing EPA, either registered or unregistered, it can
still continue to be used. If, at some time you are no longer able to
make financial decisions for yourself then the EPA will need to be
registered before it can continue to be used.
If you have already made an EPA and you still have capacity, you
can either replace it with a new property and affairs LPA or you can
keep your existing EPA. For more information on how to do this you
should contact Customer Services at the Public Guardianship Office
(PGO) on 0845 330 2900.
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Finally, even if you already have an EPA (which only applies to
finance and property matters), you will also be able to make an
additional LPA for personal welfare decisions under the new law.
If you have an EPA or an LPA, under the new law the attorney will
have to make sure they are making decisions in your best interests.
Making an advance decision to refuse treatment
An advance decision allows you to set out particular types of
treatment you do not want should you lack the capacity to decide
this for yourself in the future. Advance decisions are legally binding
and must be followed by doctors and other health professionals, as
long as they meet certain conditions.
People can already make advance decisions, currently also known
as ‘living wills’ but the Act introduces a number of rules that you
must follow when making an advance decision for them to be valid
and applicable. If you already have an advance decision you should
check that it meets these rules if you want it to take effect.
At the time that you make an advance decision, you must be 18
or over and have the mental capacity to make such a decision. It
should make clear which treatments you are refusing, (although you
do not have to use detailed medical terms) and you should explain
which circumstances the refusal refers to. A doctor will need this
information to decide whether an advance decision is valid and
applicable to a particular treatment. If you are refusing treatment
because of a particular religious or philosophical point of view then
it is helpful to explain this in your advance decision.
You cannot make an advance decision to ask for a particular treatment
– you can only say what types of treatments you would refuse.
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An advance decision does not need to be in writing except for
decisions relating to life-sustaining treatment (see below), but it
is helpful if it is. You can get someone to write it down for you if
you prefer. It is a good idea to talk to a doctor or nurse or patient
support group before making an advance decision, but this is
entirely up to you.
If you decide to make an advance decision, you should keep it up
to date as your views and wishes may change over time. Health
professionals may decide that an advance decision is not valid in
circumstances where, since making it, you have done anything
clearly inconsistent with the advance decision or you have made an
LPA with authority to consent to, or refuse, the proposed treatment.
Making advance decisions about life-sustaining treatment
Some people choose to make an advance decision knowing that it
may have the effect of shortening their life.
‘Life-sustaining treatment’ is any treatment that is needed to keep
you alive and without which you might die. There are some specific
rules to follow if you want to make an advance decision to refuse
life-sustaining treatment.
This type of advance decision must:
be in writing
contain a specific statement which says that your advance
decision applies even if your life is at risk.
The decision must be:
signed by you (or by someone else that you appoint, in your
presence, if you are unable to sign)
signed in front of a witness
signed by the witness in front of you.
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If you do not follow these rules then your advance decision to
refuse treatment may not apply to life-sustaining treatment.
Example:
Anthony has recently been told he has Motor Neurone Disease
and wants to plan for the future. He has very strong beliefs on
what treatment he would and would not want when he becomes
seriously ill and when he is close to dying. He has decided he
does not want to be fed or given fluids by a tube to keep him
alive when he is about to die. Anthony is concerned that if he is
unable to make a decision in the future, the doctors may make it
for him.
Anthony writes an advance decision stating that in the future
when he is close to dying he does not want to receive artificial
nutrition or hydration (food and fluid by tube). The advance
decision includes a written statement confirming that Anthony
does not wish to receive artificial nutrition or hydration even if
his life is at risk. Anthony signs the advance decision and a close
friend of his witnesses his signature. The friend then signs the
advance decision in front of Anthony.
This advance decision must be followed if and when it becomes
relevant.
What if I already have an advance decision (or ‘living will’)?
If you have already made an advance decision, sometimes known
as a ‘living will’, then it may still be valid when the Act comes into
force. You should check that it meets the new rules, particularly if it
deals with life-sustaining treatment. More detailed guidance on this
will be available at www.dh.gov.uk/consent
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Will this change the law on euthanasia or assisted suicide?
No. You can use an advance decision to refuse life-sustaining
treatment. However, you cannot use the advance decision to ask
for your life to be ended. The new Act makes clear that it will not
change the law regarding assisted suicide, neither does it change
the law regarding murder or manslaughter.
Advance decisions and the Mental Health Act 1983
Advance decisions do not allow people to refuse to be detained
or treated without consent under the Mental Health Act. This is
because people who have capacity to consent cannot refuse such
detention or treatment.
Example:
John is 29 years old and has experienced mental health problems
most of his adult life. He sometimes hears voices telling him to
hurt himself and on three occasions now, has been detained in
hospital under section 3 of the Mental Health Act 1983. John
has been treated with injections of antipsychotic medication
whenever he has been detained (‘sectioned’). John does not like
having these injections as they make him feel physically ill and he
has come to the conclusion that the side effects of the injections
outweigh the benefits. He writes an advance decision stating that
he does not wish to be treated with these injections in the future.
He signs this in front of a close friend who then signs it in front
of John. He then arranges for a copy of the advance decision
to be placed in his health records held by the hospital and the
local community mental health team. A few months later, John
becomes extremely distressed by the voices in his head and is
admitted to hospital under section 3 of the Mental Health Act.
The psychiatrist treating John wants to administer an injection but
John is so distressed that he lacks the capacity to give consent
to the injection. The psychiatrist sees that John has made an
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advance decision but, after careful consideration, decides that it
is better for John to have the injection than not as the voices are
telling John to hurt himself. The psychiatrist also gives John other
medication to help him cope with the side effects of the injection.
The advance decision has been made correctly but because John
has been admitted to hospital under the Mental Health Act he can
be treated for his mental health problem without his consent.
Recording your wishes and feelings about treatment and care
You can also write down or tell people about your wishes and
preferences about your future treatment or care. These must be
taken into account when determining what is in your best interests.
Such statements can request certain types of treatment, which
must be carefully considered, especially if they have been written
down, but they will not always dictate the decision the person
makes on your behalf as the key issue will be your best interests
(see part 4).
These statements can be about anything, including personal
preferences such as having a shower rather than a bath, or wanting
to sleep with the light on. However, you cannot use such a statement
about preferences you may have to ask for your life to be ended.
Example:
Khalid is vegetarian and has a degenerative condition. He wants
to make sure that if he loses mental capacity and needs people to
help him with daily tasks that they recognise his personal beliefs.
He therefore writes down a statement explaining that he only
wishes to receive vegetarian food. Khalid asks for the statement
to be filed with his health record so that in the future, if he can no
longer make and communicate his own decisions, he receives
food in line with his wishes.
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6. What further support is available?
Support from family and friends
It may be useful to talk to different people before you actually make
a Lasting Power of Attorney or advance decision. This could include
talking to a GP or other health professional, solicitor, and family and
friends. A number of organisations offer advice and support on the
Act (see part 12).
Support from an advocate
Advocacy is also a useful source of support for you if you currently
lack the capacity to make a decision or if you are worried that you
may lack capacity in the future. An advocate is an independent
person who helps to make sure your wishes are expressed and that
your voice is heard.
Advocates are experienced in working with people who have not
been fully and properly involved in decisions which affect their lives.
Some organisations that provide advocacy are listed in part 12.
Support if you do not have any family or friends
In most situations, people who lack capacity will have a network of
support from family members or friends who take an interest in their
welfare, or from a deputy (see part 10) or an attorney appointed
under a Lasting Power of Attorney (see part 5).
However, some people who lack capacity may have no one (other
than paid staff) to support them with major decisions which will
change the person’s life. The Act creates a new advocacy service
called the Independent Mental Capacity Advocate (IMCA) which
will be available from April 2007 in England and October 2007 in
Wales. An IMCA is a specific type of advocate that will only have
to be involved if you do not have anyone appropriate who can be
consulted. An IMCA will only be involved in specific situations:
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where the decision is about serious medical treatment provided
by the NHS
it is proposed that the person is moved into long-term care of
more than 28 days in hospital or 8 weeks in a care home
where a long-term move (8 weeks or more) to different
accommodation is proposed, such as a hospital, care home, or
nursing home
in England, local authorities and the NHS can extend the IMCA
service to specific situations if they are satisfied that an IMCA
would provide particular benefit. These are:
care reviews about accommodation or changes to
accommodation, and
adult protection cases (even if the person who lacks
capacity has family and/or friends)
in Wales, the National Assembly for Wales will announce later in
2007 if local health boards and local authorities will be able to
extend the IMCA service to these situations.
The IMCA Service is a new service to help support and protect the
rights of particularly vulnerable people who lack capacity. The role
of an IMCA is to support and represent you by:
obtaining and evaluating relevant information - an IMCA can
talk to you in private and examine and take copies of health and
social care records such as clinical records, care plans or social
care assessment documents
discussing the proposed decision with professionals and others
involved in your care and treatment
finding out, as far as possible, your wishes and feelings - taking
into account your beliefs and values
considering alternative courses of action and suggesting these
to the decision-maker
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getting a further medical opinion where necessary, where the
decision or action is about medical treatment
providing a report with submissions for the person making the
decision.
If the IMCA disagrees with the decision made, they can also
challenge the decision-maker.
If a situation arises where an IMCA is required, the person in the
NHS or local authority who is making the decision (for instance a
doctor or social worker) will request an IMCA for the person who
lacks capacity.
Example:
Nikita has a learning difficulty and does not use verbal
communication. She lives in a residential home that is closing and
has no family or friends who visit her regularly.
Nikita’s social worker contacts the Independent Mental Capacity
Advocate (IMCA) service and requests an IMCA to represent
Nikita and make sure her views are taken into account when the
decision about a new home is made.
The IMCA spends time with Nikita at her home and the day
service she attends. The IMCA also talks to the care staff about
what Nikita appears to like doing. Nikita enjoys horse riding, but
does not like being with more than two or three people at a time.
Nikita likes to eat on her own and to watch movies with another
woman at the home.
The IMCA uses this information to put forward Nikita’s views
about the type of home she would like to move to.
You can get further information on this in the Code of Practice
which supports the Act and you can look at the Department of
Health’s IMCA web pages by going to www.dh.gov.uk/imca
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7. What will happen if I have not planned ahead?
If you have not planned ahead, and a decision about your money,
health or lifestyle needs to be made when you lack the capacity to
make the decision then someone else will have to decide what to do.
Decisions will be made in your best interests which is explained in
part 4 of this booklet.
The new law says that actions regarding your care and
treatment can be carried out by someone else, as long as they
are done in your best interests and follow the principles of
the Act (see part 4). This could cover a wide range of actions
carried out by carers or professionals such as assistance with
washing, dressing, eating or mobility.
If something needs to be done about your property and
financial affairs such as redeeming an insurance policy or
selling your house, then someone can apply to the new Court of
Protection to deal with the situation, in your best interests. The
Court will have authority to make orders about any healthcare
or financial matters. There is a more detailed explanation of the
role and remit of the new Court of Protection in part 10.
For complex or ongoing financial decisions or where a series of
steps may be needed over a long period, the Court can appoint
a deputy to make decisions for you. Again, the deputy must
always act in your best interests, as explained in part 10.
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8. Challenging decisions and raising concerns
You may disagree with the way you are being treated when you lack
capacity. For example, if you have concerns about decisions made
on your behalf, or actions being carried out connected to your care
and treatment, or you may dispute the assessment made about
whether or not you lack capacity to make a decision.
There are a number of ways that you can get help raise concerns,
and it is recommended that you try to use informal methods first,
before taking any legal or formal action. Informal methods could
include using independent advocacy (see part 6) or mediation.
If you have a complaint about a healthcare related issue, the
Patient Advice and Liaison Service (PALS) in England provides
an informal way to resolve disputes quickly. PALS is an advisory
body to support patients and families, and it does not investigate
complaints. The equivalent agency in Wales is the local Community
Health Council.
You can contact PALS by:
phoning your local hospital, clinic, GP surgery or health centre
and ask for details of the PALS
phoning NHS Direct on 0845 46 47
searching the Office Directory on the PALS Online website:
www.pals.nhs.uk
If the complaint is still not resolved, or if it is a serious dispute,
more formal methods can be used to raise concerns. For health
related issues in England, the Independent Complaints Advocacy
Service (ICAS) supports people to take forward NHS complaints in
a more formal way. You can contact your local ICAS office direct, or
through NHS managers at hospitals and GP practices, NHS Direct,
or through PALS.
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Complaints about social care can be referred in the first instance
through your local authority’s complaints procedures.
You will also be able to raise concerns and get general information
about disputes under the Mental Capacity Act by contacting the
Customer Contact Centre at the Office of the Public Guardian
(see part 10).
Finally, the Court of Protection (see part 10) will have the authority
to make decisions about capacity and deal with disputes under the
Act. There will be a procedure in place to appeal against a decision
made by the Court of Protection.
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9. What does the Act say about research?
Research is an important way for us to understand illness and
disability and to improve the care and support people receive.
This could include testing how effective a certain type of care or
treatment is in supporting those who may lack capacity, or finding
out what caused a condition such as Alzheimer’s disease.
Sometimes this research will only be useful if it involves people who
lack the mental capacity to agree to take part, such as investigating
what causes conditions like dementia.
The Act allows such research to take place but sets out strict
rules to protect people who lack capacity to consent to take part
in research and to make sure their current or previous wishes are
taken into account. These include:
The research must be agreed by a recognised independent
Research Ethics Committee to say it is necessary, safe and
cannot be done another way using people who have capacity.
Researchers must talk to a family member, carer or other
relevant person (such as an attorney or deputy) about whether
to involve the individual who lacks capacity in the research. If
they say the person who lacks capacity would not want to be
involved in the research, it cannot take place.
The research must not continue if the person shows signs of
not wanting to be involved.
The possible benefits of taking part in the research must be
greater than any potential risk or harm to the person, or it must
help other people and will not hurt or upset the person.
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Example:
George is asked to take part in a research project designed to
study what effects an exercise programme has on the lives of
people with Alzheimer’s. The only way the researchers can test
this is by involving people with Alzheimer’s in the research. The
panel of experts have already agreed that the participants may
benefit from the study, and that the study will provide information
that will be useful to others who work with people with
Alzheimer’s. They also agree that the study does not put those
taking part at risk.
George is not able to understand the detail of the study so the
researcher consults George’s wife who agrees that he would have
been interested in taking part in this sort of study. George is able
to make decisions about which exercises he wants to take part in
each day and the researcher respects these decisions.
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10. How the new law is being supported
Code of Practice
The Act is supported by guidance in the Code of Practice, which
provides guidance on how the Act will work in reality. The Code has
legal status and certain people must have regard to it when they
act in relation to a person who lacks capacity to make a decision.
This means that they must pay attention to the Code and be able
to show that they are familiar with the guidance in it. If they don’t
follow the Code they should be able to give convincing reasons why
not. These people include attorneys, deputies, IMCAs, professionals
(such as doctors, social workers and lawyers) and people being
paid for their work (such as paid carers).
Unpaid carers and family members won’t have the same duty but
they are still expected to follow the general principles and will find
the guidance useful. The Code of Practice is designed to help them
use the principles of the Act when making day-to-day decisions for
a person who lacks capacity.
Court of Protection
The current Court of Protection only deals with decisions about
finances and property. Health and welfare decisions are currently
dealt with by the High Court.
The Act will create a new specialist Court of Protection from
October 2007. The Senior Judge will be based in London and he
will be assisted by specially trained judges who will be based at key
locations in England and Wales. This will mean that any hearings
can be nearer to the people concerned. The Court will have to make
decisions in the best interests of the person who lacks capacity.
The Court will make final decisions on capacity if there is
uncertainty whether a person is able to make the decision in
question. It will deal with decisions about the finance and property
of a person who lacks capacity and also certain serious health/
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welfare decisions most commonly where there is a dispute about
best interests. The Court will normally only hear personal welfare
cases where parties have not been able to reach consensus about
what is in the person’s best interests by other means (see part 8).
The Court has powers to make tailor-made orders if this is thought
to be in a person’s best interests such as allowing someone to sign
a tenancy agreement on behalf of a person with learning disabilities.
It will also be able to appoint deputies (see below) with ongoing
authority to make decisions for a person who lacks capacity.
Although many Court hearings will take place in key regional
locations all applications should be made initially to the Court of
Protection’s Central Registry in Archway, North London. The Central
Registry will deal with any urgent interim directions required and will
then if necessary refer the matter to be heard at a regional court if
this is more appropriate.
Some people will need to get the Court’s permission to make an
application. The rules about this will be set out in the application
forms and guidance.
There will be more information about how you can access the Court
of Protection and who needs to seek permission for Court action
nearer to October 2007. It will be available in leaflet form and on the
OPG website. The OPG Customer Contact Centre will always be a
first point of contact and able to give advice (see part 11).
There will be a procedure in place to appeal against a decision
made by the Court of Protection.
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Deputies
If it is necessary to give someone continuing authority to deal with a
series of long-term issues, the Court can appoint a deputy to make
decisions on a person’s behalf. This must be someone who is aged
18 years or over, and can be (among others) a relative, friend, or a
professional, such as an accountant or doctor, or the Director of
Social Services. If no one is able or wants to be a deputy, the Court
can appoint a deputy from an approved panel.
The Court will tailor the powers of the deputy, based on the
circumstances of the case. The deputy must always act in the
person’s best interests (see part 4). The Office of the Public
Guardian (see below) will make sure that deputies are doing their
job properly, and a deputy will be accountable to the Court of
Protection for any decisions they make on behalf of a person who
lacks capacity.
You will be able to get more information about the duties of a
deputy from the Office of the Public Guardian (see part 11).
What if I already have a receiver?
From October 2007 when the new Act comes into force, existing
receivers will continue to act as before, but will be known as a
deputy for property and affairs. More information will be sent to
receivers nearer October 2007. If at any later stage a health and
welfare deputy needs to be appointed, a separate application will
need to be made. For more information please go to:
www.guardianship.gov.uk
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Office of the Public Guardian
From October 2007, the Act creates a new public official - the
Public Guardian. The Public Guardian will be supported by a new
Office of the Public Guardian, (OPG). The OPGs role is to:
register LPAs and EPAs
supervise deputies appointed by the Court of Protection
(see above)
provide information to the Court of Protection
give information and guidance on the Mental Capacity Act to
the public.
The OPG will also help support attorneys and deputies to do their
jobs. It will work closely with other organisations who support
adults who have difficulty making their own decisions and will also
work with the police and social services to respond to any concerns
raised about the way in which an attorney or deputy is working.
The OPG will also look at problems or possible abuse and will send
serious concerns to the Court of Protection.
The OPG will provide a Customer Contact Centre which will be the
first point of contact for anyone who needs advice or information
about the Mental Capacity Act, becoming a deputy, or making an
LPA or registering either an LPA or an EPA.
The functions of the Public Guardian will be monitored by the Public
Guardian Board and will need to produce an Annual Report about
what work it has been doing.
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11. What if I want to know more about the MCA?
If you would like to know more about the Mental Capacity Act you
can call 0845 330 2900 or email makingdecisions@dca.gsi.gov.uk
Other sources of useful information and guidance includes:
Title Available from
Other information booklets
like this one
You can view these electronically by
going to: www.dca.gov.uk/legal-policy/
mental-capacity/publications.htm
To order hard copies you can email:
reorder@inprintlitho.com
The Mental Capacity Act
2005
You can view this for free by going to:
www.dca.gov.uk/legal-policy/mental-
capacity/index.htm
Or you can order a hard copy from TSO
by calling 0870 600 5522 or emailing
customerservices@tso.co.uk
The Code of Practice for the
Mental Capacity Act
When the Code is published you will be
able to download it for free by going to:
www.dca.gov.uk/legal-policy/mental-
capacity/index.htm
You can order a hard copy from TSO
by calling 0870 600 5522 or emailing
customerservices@tso.co.uk.
Information on the IMCA
service, IMCA Pilots and
training materials for
IMCAs
www.dh.gov.uk/imca
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The following government departments are working together to
implement the Mental Capacity Act in 2007
Department What it is/does
Contact
Department for
Constitutional
Affairs (DCA)
Responsibilities include
running the courts, and
improving the justice system,
human rights, information
rights law, policy on running
elections and modernising the
constitution
5th Floor Steel House, 11 Tothill St,
London, SW1H 9LH
www.dca.gov.uk/
E makingdecisions@dca.gsi.gov.uk
Department of
Health (DH)
Responsibilities include setting
health and social care policy
in England. The Department’s
work sets standards and
drives modernisation across all
areas of the NHS, social care
and public health
Wellington House, 133-155
Waterloo Road, London, SE1 3UG
www.dh.gov.uk
T 020 7210 4850
Public
Guardianship
Office (PGO)
The administrative arm of
the Court of Protection and
part of the Department for
Constitutional Affairs. It
provides financial protection
services for clients who are not
able to manage their financial
affairs because they lack
capacity
Archway Tower, 2 Junction Road,
London, N19 5SZ
www.guardianship.gov.uk
T 0845 330 2900
E custserv@guardianship.gsi.gov.uk
Welsh Assembly
Government
Develops policy and approves
legislation that reflects the
needs of the people of Wales
Cathays Park, Cardiff, CF10 3NQ
www.wales.gov.uk
T 029 2082 5111
12. Some useful contacts
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The following organisations were involved in writing and advising
on this booklet
Organisation What it is/does Contact
Making
Decisions
Alliance
It includes: Action on Elder Abuse, Age Concern England, Alzheimer’s
Concern Ealing, Alzheimers Society, Beth Johnson Foundation, Carers
UK, Centre for Policy on Ageing, Cloverleaf Advocacy, Consumer
Forum, Different Strokes, Down’s Syndrome Association, Foundation
for People with Learning Disabilities, Headway, Help the Aged,
Horsham Gateway Club, Independent Advocacy Service, Kent
Autistic Trust, Leonard Cheshire, Mencap, Mental Health Foundation,
Mind, Motor Neurone Disease Association, National Autistic Society,
North Staffordshire Users Group, The Oaklea Trust, Patient Concern,
Powerhouse, Relatives and Residents Association, Respond,
Rethink, Rett Syndrome Association, St Clements Patient Council,
Scope, Sense, Skills for People, Stroke Association, Turning Point,
United Response, WITNESS
www.makingdecisions.org.uk
Action for
Advocacy
A resource and support
agency for the advocacy
sector, information, training
and advice
PO Box 31856, Lorrimore Square,
London, SE17 3XR
www.actionforadvocacy.org
Age Concern
England
The UK’s largest organisation
working to promote wellbeing
of all older people. It provides
vital services, information
and support to thousands of
older people - of all ages and
backgrounds
Astral House, 1268 London Road,
London, SW16 4ER
www.ageconcern.org.uk
www.accymru.org.uk
Information line 0800 00 99 66
Alzheimer’s
Society
The UK’s leading care and
research charity for people
with dementia, their families
and carers
Gordon House, 10 Greencoat
Place, London, SW1P 1PH
www.alzheimers.org.uk
Helpline 0845 300 0336
British Medical
Association
(BMA)
BMA represents doctors from
all branches of medicine all
over the UK
BMA House, Tavistock Square,
London, WC1H 9JP
www.bma.org.uk
T 020 7387 4499
F 020 7383 6400
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Organisation What it is/does Contact
Carers UK
Looks after family, partners
or friends in need of help
because they are ill, frail or
have a disability
20/25 Glasshouse Yard, London,
EC1A 4JT
www.carersuk.org
T 020 7566 7637
F 020 7490 8824
Down’s
Syndrome
Association
Provides information and
support for people with
Down’s Syndrome, their
families and carers, as well as
being a resource for interested
professionals
Langdon Down Centre, 2a Langdon
Park, Teddington, Middlesex,
TW11 9PS
www.dsa-uk.com
T 0845 230 0372
F 0845 230 0373
Foundation
for People
with Learning
Disabilities
Works with people with learning
disabilities, their families and
those who support them to
improve the quality of their lives
and promotes the rights, quality
of life and opportunities of
people with learning disabilities
and their families
Sea Containers House, 20 Upper
Ground, London, SE1 9QB
www.learningdisabilities.org.uk
T 020 7803 1100
Headway
– the brain injury
association
Promotes understanding of
all aspects of brain injury; and
provides information, support
and services to people with
a brain injury, their family and
carers
4 King Edward Court Service,
King Edward Street, Nottingham,
NG1 1EW
www.headway.org.uk
Helpline 0808 800 2244
MENCAP
Charity working with people
with learning disabilities, their
families and carers
123 Golden Lane, London,
EC1Y ORT
www.mencap.org.uk
T 020 7454 0454
Mental Health
Foundation
A leading UK charity that
provides information, carries
out research, campaigns and
works to improve services for
anyone affected by mental
health problems, whatever their
age and wherever they live
Sea Containers House, 20 Upper
Ground, London, SE1 9QB
www.mentalhealth.org.uk
T 020 7803 1100
MIND
Leading mental health charity,
working to create a better life
for everyone with experience
of mental distress. Provides
information and support
15-19 Broadway, Stratford, London,
E15 4BQ
www.mind.org.uk
Infoline 0845 766 0163
Making decisions about your health, welfare or finance
42
Who decides when you can’t?
43
Organisation What it is/does Contact
National Autistic
Society (NAS)
Champions the rights and
interests of all people with
autism and to ensure that
they and their families receive
quality services appropriate to
their needs
393 City Road, London, EC1V 1NG
www.autism.org.uk
Helpline 0845 070 4004
National Care
Association
(NCA)
Represents the interests and
provides services to support
small and medium sized
providers of social care in
England and Wales
45-49 Leather Lane, London,
EC1N 7JT
www.nca.gb.com
T 020 7831 7090
National Care
Forum
Established to represent the
interests of not-for-profit health
and social care providers in the
United Kingdom
3 The Quadrant, Coventry,
CV1 2DY
www.nationalcareforum.org.uk
T 024 7624 3619
The National
Family Carer
Network
A network that provides a
focal point for issues affecting
families that include an adult
with a learning disability
Merchants House, Wapping Road,
Bristol, BS1 4RW
www.familycarers.org.uk
T 0117 930 2600
The National
Family Carer
Support Service
A network that provides
support and information for
family carers
Merchants House, Wapping Road,
Bristol, BS1 4RW
www.hft.org.uk
T 0117 930 2608
Patient Concern
An organisation committed
to promoting choice and
empowerment for all health
service users. Provides
information to service users
PO Box 23732, London, SW5 9FY
www.patientconcern.org.uk
E patientconcern@hotmail.com
The Relatives
and Residents
Association
An organisation for older
people needing, or living
in, residential care and the
families and friends left
behind. Offers support and
information via a helpline
24 The Ivories, 6-18 Northampton
Street, London, N1 2HY
www.relres.org
Helpline 020 7359 8136
RESCARE
The national society for
children and adults with
learning disabilities and their
families
Steven Jackson House, 31 Buxton
Road, Heaviley, Stockport, SK2 6LS
www.rescare.org.uk
T 0161 474 7323
CONTENTS BACK NEXT CONTENTS BACK NEXT
Making decisions about your health, welfare or finance
44
Organisation What it is/does Contact
RESPOND
Provides a range of
services for both victims
and perpetrators of sexual
abuse who have learning
disabilities and those who
have been affected by other
trauma. Their services extend
to support and training
for families, carers and
professionals
3rd Floor, 24-32 Stephenson Way,
London, NW1 2HD
T 020 7383 0700
F 020 7387 1222
www.respond.org.uk
Helpline 0808 808 0700
Scope
Disability organisation in
England and Wales, whose
focus is people with cerebral
palsy
6 Market Road, London, N7 9PW
www.scope.org.uk
T 020 7619 7100
Sense
Charity providing specialist
information, advice and
services to deaf blind people,
their families, carers and the
professionals who work with
them. Funded to develop
training materials which
address the advocacy issues
for deaf blind people
11-13 Clifton Terrace,
Finsbury Park, London, N4 3SR
www.sense.org.uk
T 0845 127 0060
F 0845 127 0061
Text 0845 127 0062
Turning Point
The UK’s leading social
care organisation, providing
services for people with
complex needs, including
those affected by drug and
alcohol misuse, mental health
problems and those with a
learning disability
New Loom House, 101 Backchurch
Lane, London, E1 1LU
www.turning-point.co.uk
T 020 7702 2300
United
Response
A national organisation
creating opportunities and
services with people with
learning difficulties and people
with mental health problems
113-123 Upper Richmond Road,
Putney, London, SW15 2TL
www.unitedresponse.org.uk
T 020 8246 5200
F 020 8780 9538
Minicom 020 8785 1706
CONTENTS BACK NEXT
Other booklets in this series include:
2 Making decisions. A guide for family, friends and other
unpaid carers
3 Making decisions. A guide for people who work in health
and social care
4 Making decisions. A guide for advice workers
5 Making decisions. An Easy Read guide
These booklets are available in other formats on request.
To order:
T 023 80 878038 or 023 80 878036
F 023 80 528324
E reorder@inprintlitho.com
The booklets are also available online at:
www.dca.gov.uk/legal-policy/mental-capacity/publications.htm
The Mental Capacity Implementation Programme published
this booklet. It was written by Turning Point, Scope and Mind
who are members of the Making Decisions Alliance.
2nd edition February 2007
© Crown copyright 2006
CONTENTS BACK
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