This document discusses applying the Mental Capacity Act 2005 in practice through a care planning discussion for a patient named Gertrude. Key areas discussed include Gertrude's background and condition, assessments of her capacity, risks of allowing her to leave the hospital, and decision making around her best interests and potential discharge plan. The document prompts critical thinking around these issues in the context of the Mental Health Act 1983, Mental Capacity Act 2005, advocacy, capacity statements, best interest assessments, and deprivation of liberty safeguards.

1. Action Learning

2. What are we doing? Aims Learning to apply the Mental Capacity Act 2005 in practice. Through Care Planning discussions By Applying the Act to real life experiences Discussion to promote learning. Key words and prompts Small group work Videos Critical Analysis

3. Models of learning Experience Reflective observation Abstract conceptualisation Active experimentation

4. Critical Practice

5. Critical practice

6. Welcome to Arnham Home for the Emotionally Troubled. Set in a hospital setting ( although this could be a nursing home) You have recently taken a job as a staff nurse called Ralf. You are getting to know your patients and you are given Gertrudeto be named nurse for. There is a Care Programme Approach meeting taking place in 1 weeks time, and the team are looking for a discharge plan.

7. Autonomy Advocacy Mental Health Act 1983 Mental Capacity Act 2005 Risk Right to freedom of choice Team working and the MDT Carer and service user involvement Capacity Statements and Best Interest Assessment Record keeping Key words to think about when watching the Video

8. Get together in small groups Talk about the video and ask yourselves: What other information you need to care plan to Gertrude? And from whom? What is in Gertrude’s best Interests? How to Advocate for Gertrude Should Gertrudebe allowed to Leave Hospital. Think about Use a mind map to help you reach your decisions Why? How? What? Where? When? and use the Key word terms to Prompt you. Talk about your experiences of the Mental Health Act and the Mental Capacity act in the group.

9. Who are we meeting? Gertrudehas been in hospital for 10 months. She came in with extremely poor self care , she had scabies and lice and evidence of malnutrition. She lives with her husband who is called Eddie. Her daughter (age 21) is called Jolene and her son ( age 26) is called Leroy. None of the family work at present. She had been cooking, cleaning and driving a car without supervision immediately prior to admission. Her family report on a holiday to Eastbourne just before coming into hospital, that she nearly ‘ killed them all’ while driving. Gertrudewas aggressive towards her family and would chase them around the house, Jolene was so scared she had locked herself in the dining room until her brother had arrived home on one occasion. Gertrudelikes cooking and looking after her family, she enjoys knitting and puzzles. Before she retired, she used to be a school cook.

10. Who are we meeting? She recently scored 20 out of 30 on a Mini Mental State Examination. It showed that she was not orientated to time and place and that she has poor recall. Her speech is repetitive and she has extremely poor short term memory. Her family have been encouraged to take her home over the recent Christmas holidays and they did not come and pick her up on Christmas day, this upset her. They have only taken her home for 6 hours in 10 months. A recent Carer Assessment showed that the family are possibly able to care for her, but there is evidence of an unwillingness to take responsibility for her safety while she is at home and they are putting the block on any leave periods. He daughter says she is still scared of her mum despite reassurance that she is no longer aggressive. Her husband has heart disease and COPD and is unwell himself. Leroy says that he will help when he can, but is looking for a job working on the rigs. There is evidence of Jolene already being a carer for Eddie.

11. Who are we meeting? A recent Occupational Therapy assessment showed that Gertrudeneeds supervision to perform many tasks such as cooking ( she is fire risk because she thinks she can still cook). She is at risk of getting lost if she left the house on her own. She believes she can still drive a car . She believes herself to be a safe driver. Whenever you challenge her about her memory she states she will be alright and just wants to go home. Her self care remains poor in hospital, she requires prompting to bathe but she is resistive and tells the nursing staff she has already performed tasks when there is evidence she has not. Her aggression had diminished while she is in hospital and she is taking Aricept. She is an informal patient. Every ward round she asks to leave hospital and go home, she is ‘convinced’ to stay and quickly forgets she has asked to leave.

12. Decision Making Tree Are they detainable under the Mental Health Act 1983? What is the question we are asking of MCA 2005? IS IT APPLICABLE? Does the Service User have CAPACITY? What assessments do we need? Have we completed a Best Interest Assessment? What about Service User and carer involvement? What does the Service User want? How severe are the risks? Mental Health Act Are the risks able to be managed at home? Mental Capacity Act Capacity Statement Deprivation of Liberty ( DOLS) Care Planning IMCA

13. Checklist for Capacity IMCA Advocacy Best Interest Checklist DOLS assessments

14. What happened next? Alternative Endings Alternative uses? Physical Intervention Refusing treatment Contraception Breaking confidentiality Hyperlinks Mental capacity Act 2005 www.legislation.gov.uk/ukpga/2005/9/contents Bournewood enquiry www.justice.gov.uk/consultations/docs/cp2307-easy.pdf

15. Conclusion Mental Health Act Mental Capacity Act Best Interest Assessments IMCA and advocacy DOLS Care Planning Reflective Practice Critical Analysis and reflection. What have we learnt?