If your relative is finding it increasingly difficult to make decisions, the Mental Capacity Act can help. It supports people who want to plan for the future and ensures that their best interests are protected when they can no longer make decisions for themselves.  

On this page you can find detailed information about the Mental Capacity Act, including

1. What is mental capacity?
2. Dementia and mental capacity
3. The Mental Capacity Act 2005 (England and Wales)
4. Adults with Incapacity (Scotland) Act
5. The Mental Capacity Bill (Northern Ireland)

What is mental capacity?

Everyone should have the right to make choices about their own life. But sometimes injury, illness or disability can limit someone’s capacity to understand complex choices and make decisions. Someone’s mental capacity could be affected by:

  • a brain injury
  • dementia
  • a stroke
  • a severe learning disability.

Every situation is different. In some cases, a person’s mental capacity might only be affected temporarily. Or it may fluctuate over time, meaning that they are able to make decisions one week but not the next. Or they might be able to make day-to-day decisions about shopping and meals, but be unable to make bigger decisions about financial affairs or care options.

Dementia and mental capacity

A person in the early stages of dementia might take longer to communicate, process information and understand choices. But this doesn’t necessarily mean that they have lost mental capacity and can’t make their own decisions.

If your relative seems to be finding it difficult to understand or make choices, try thinking of different ways to help them. Are there other ways to explain the situation? Would it help to leave them with written information, rather than simply explaining verbally? Our guide on Communicating with someone who has dementia offers useful advice.

The Mental Capacity Act 2005 (England and Wales)

The Mental Capacity Act protects people who lack the mental capacity to make decisions about their care and treatment. It is aimed at empowering individuals to make their own decisions for as long as possible.

It applies to individuals aged 16 and over living in England and Wales. Scotland has its own legislation that covers mental capacity and Northern Ireland is working on a draft Mental Capacity Bill (for more information on both of these pieces of legislation, see the bottom of this article).

The Mental Capacity Act covers:

  • How to plan for the future
  • How mental capacity is assessed
  • Who can make decisions on someone else’s behalf and what rules they have to follow.

It says that:

  • It should always be assumed that someone has the capacity to make their own decisions, unless they’ve had a capacity assessment that proves otherwise.
  • Individuals should be supported to make their own decisions wherever possible.
  • Any decisions made on behalf of someone else must be in their best interests.

Advance care planning

Thinking about the future can be difficult, but if your relative has an illness (such as dementia) where their ability to make decisions is likely to get worse, planning ahead can help them feel reassured that their wishes will be known and acted on by the people caring for them. 

The Mental Capacity Act (MCA) allows people to set down their wishes for the future in case there comes a time when they are no longer able to make decisions for themselves. Under the MCA people can:

  • Appoint a trusted person (Power of attorney) to make decisions on their behalf should they lack capacity in the future.
  • Write an ‘advance statement’ expressing their preferences for care and treatment. These are not legally binding but should be taken into account by those considering the person’s best interests.
  • Make ‘advance decisions’ (also known as a ‘living will’) about certain medical or healthcare treatment that they would not want if they ever lacked capacity to refuse it.  For example, they might not want to receive life-saving treatment in the event of certain illnesses. Advance decisions are legally binding, although there are exceptions. Which? Wills provides more information about Living wills.

Who decides if someone has mental capacity?

Under the Mental Capacity Act a person has the right to make their own decisions until they have been assessed by a health professional as lacking in mental capacity. The health professional will have to consider if the person can:

  • understand information related to the decision
  • remember information for long enough to make a decision
  • weigh up or use the information to reach a decision
  • communicate their decision to others, for example by talking, using sign language or hand signals, or squeezing someone’s hand.

Remember, even if someone is assessed as lacking in mental capacity:

  • this might only apply to some, not all, decisions
  • it’s not always permanent and they might be able to make their own decisions at a later time.

Who can make decisions for someone that lacks mental capacity?

If your relative is assessed by a health professional as lacking mental capacity, someone else will need to make decisions on their behalf. There are two main options.

A lasting power of attorney: If your relative appointed a power of attorney, this will now come into force. Remember that a power of attorney can only be made while someone still has mental capacity. For more information about the different types, costs and how to apply, see our Power of attorney guide.

Deputy: If your relative did not appoint a power of attorney, then the Court of Protection will appoint a deputy to make decisions on their behalf. The Court decides who the deputy will be – it might be a trusted relative or friend, or a professional with the relevant skills. You can apply to become a deputy on the GOV.UK website. The Court can also decide the length of the appointment and what types of decisions the deputy can or can’t make.

A deputy appointed to make healthcare or personal care decisions on a person’s behalf can decide things like where they live, the type of care they receive and whether or not they should have medical treatment that doctors consider is in their best interests.

A deputy cannot make a decision that:

  • the person has the capacity to make for themselves
  • goes against a decision made by an attorney acting under a  lasting power of attorney
  • they have not been authorised to make by the Court of Protection
  • refuses treatment that would help the person stay alive for longer, should they develop a life-threatening medical condition
  • the person has already covered in an Advance decision.

The Office of the Public Guardian supervises deputies in England and Wales. You can complain to them if you think that a deputy is not acting in your relative’s best interests (see our Useful organisations and websites page).

Adults with Incapacity (Scotland) Act

This Act protects adults (aged 16 and over) living in Scotland who lack mental capacity to make some or all of their own decisions.  It allows people to make plans for their future and sets rules for who can take decisions on behalf of a person who is lacking mental capacity. 

To find out more about the Act click here.

The Mental Capacity Bill (Northern Ireland)

As yet, Northern Ireland does not have specific legislation that covers mental capacity. However, the government has proposed a Mental Capacity Bill, which will cover mental capacity and mental health. Work is in progress and expected to become law in 2016. Keep an eye on the Department of Health, Social Services and Public Safety for updates.

More information

Page last reviewed: 20 May 2016
Next review due: 31 January 2018