Following the Two-Stage Capacity Test
Care Control Mental Capacity Assessments are completed in strict accordance with the Two-Stage Capacity Test mandated by the Mental Capacity Act 2005 (MCA). This legal framework is clearly outlined in Sections 2 and 3 of the Act and underpins how we assess an individual’s ability to make specific decisions at specific times.
This process is also referenced in the Care Quality Commission (CQC) guidance, which can be accessed here.
The Two-Stage Capacity Test
1. Diagnostic Test
Is there an impairment of, or disturbance in, the functioning of the mind or brain?
- This can be temporary (e.g. intoxication, delirium) or permanent (e.g. dementia, brain injury).
- A formal diagnosis is useful but not always required.
2. Functional Test
Can the individual:
- Understand the information relevant to the decision?
- Retain that information long enough to make the decision?
- Use or weigh that information as part of the decision-making process?
- Communicate their decision (via any method – speech, writing, gestures, etc.)?
If any one of these abilities is impaired due to the identified condition, the person lacks capacity to make that specific decision at that time.
Best Practice in Completing Assessments
- Care Control assessments strictly follow the two-stage process. This is a legal requirement under the MCA and must not be deviated from.
- Each assessment must relate to a specific decision. It is not lawful to conduct a general or blanket capacity assessment.
You must:
- Clearly state the decision under review.
- Comment on how the service user engages with that specific decision.
- Describe any efforts made to support their decision-making (e.g. using simple language or visual aids).
Key Principle: Decision-Specific Capacity
It is entirely possible for a person to:
- Lack capacity for one type of decision (e.g. financial management),
- But retain capacity for another (e.g. choosing their meals or care preferences).
This distinction is crucial. Regulatory bodies such as the CQC will look for evidence that assessments reflect this decision-specific and time-specific approach — a core principle of the Mental Capacity Act.