Mental capacity - everyday decisions and brain injury

Posted in Fresh Thinking

Mental capacity - everyday decisions and brain injury

What happens when brain injury affects our mental capacity to make everyday decisions, and how can Neuro OTs help in this process?


On World Mental Health Day (10 October) and in the wake of changes to the Mental Capacity Act 2005, we ask: what happens when brain injury affects our mental capacity to make everyday decisions, and how can Neuro OTs help in this process?

Impairments in cognition and communication can impact on our basic human right to be able to decide for ourselves. If we cannot clearly convey our wishes or consent, we are at risk of having that right violated.

In the UK, however, there are legal safeguards in place for people who lack mental capacity to make decisions, and these are outlined in the Mental Capacity Act (MCA) 2005, which recently underwent a few changes.

The Act aims to:


  • Protect people who lack capacity to make decisions.
  • Protect other people who make decisions on their behalf.
  • Specify criteria that need to be met when deciding on a person’s best interests.


Neuro OTs, like other healthcare professionals, work in accordance with these rules which, this year, were amended to introduce new ‘Liberty Protection Safeguards’ (LPS) and a new role for an ‘Approved Mental Capacity Professional’ (AMCP). (1)

The LPS replaces what were previously known as ‘deprivation of liberty safeguards’ which a review found were not always being used correctly and were deemed too complex.

The LPS are designed to protect vulnerable people aged 16 or over in hospital, supported living or family homes who lack the capacity to consent to their treatment and care.

And the AMCPs will be specially trained in the Mental Capacity Act to ensure the LPS are met; enhancing the current system in which a range of authorised practitioners can make decisions in a person’s best interests.


The Fundamental Five


The Mental Capacity Act 2005 outlines five, fundamental principles that must be adhered to when considering mental capacity, as follows:


  • Principle 1: Assume a person has mental capacity unless it is proven otherwise.
  • Principle 2: Give all practicable help to a person to make their own decisions
  • Principle 3: Everyone has the right to make an unwise decision.
  • Principle 4: Decisions on behalf of someone who lacks capacity must be in their best interests.
  • Principle 5: Decisions made on their behalf must be the least restrictive option.


Working to these principles, Krysalis Neuro OTs use their skills and experience to assess an individual’s capacity to make everyday decisions relating to activities, relationships and how they spend their time.

And, in accordance with Royal College of Occupational Therapists (RCOT) guidelines, Krysalis has developed a bespoke system of doing this.


Mental Capacity Assessment for Everyday Decisions


Our Mental Capacity Assessment for Everyday Decisions enables our OTs to capture relevant information through informed and specific questioning.

This defined process of assessment considers the individual’s:


  • Cognitive skills.
  • Ability to understand and retain information.
  • Use and ‘weighing up’ of information in decision-making.
  • Ability to communicate their decision.


Our OTs work alongside other health care professionals, such as doctors and psychologists, to ensure capacity assessments are thoroughly and expertly informed in order to arrive at consensus decisions made in their clients’ best interest.

Further information on assessing capacity for everyday decision can be found here:


World Mental Health Day


Organised by the World Federation for Mental Health every year on October, 10, World Mental Health Day aims to raise awareness of the latest developments in this vital field.

The UK’s Mental Health Foundation, which celebrates its 70th anniversary this year, is lending its support by hosting ‘tea and talk’ events and fund-raising through the sales of internationally symbolic green ribbon pins.


  1. Excellence, Social Care Institute for. Liberty Protection Safeguards: Latest developments. 2019.