The MCA states that we must assume that a person is capable of making a decision unless there is evidence that they cannot. All staff providing care should be comfortable with the capacity assessment, but remember that just because someone makes a decision that others think is reckless doesn`t mean they lack capacity – we all do reckless things sometimes, even when we have capacity! Using restrictive practices means doing something that prevents someone from doing what they want to do. Any practice that restricts a person`s rights or freedom of movement is a restrictive practice. This includes physical restraint, either by holding a person or using a device. But in some situations, it could also mean using medical restraints, such as tranquilizers, or solitary confinement (locking a person in a room). However, it is very important to note that the use of restrictive practices without legal justification is against the law. It should not be used without training, approval and completion of the required documentation. This is where the search for the „least restrictive option” comes in. It would be completely wrong to say, „It`s Johnny`s decision to walk on the highway, so we have to let him go.” But we must not restrict its freedoms any more than is absolutely necessary. It would be far too restrictive and unrelated to the risk of harm to lock him in the house and deny him access to nature because he may sometimes run after trucks. This is called the search for the „least restrictive alternative”. It is also a question of determining whether action is necessary or whether a decision needs to be made.
An important principle is that you should only use restrictive practices as a last resort. Simply if you`ve tried other options and they didn`t work, but someone is at risk of getting hurt. Use only restrictive interventions to ensure the safety of one or others, and the least restrictive option should always be used. Much of the CMA is not new and simply translates into law what existed in best practices. And it makes assessing a person`s abilities much easier than it often seemed in the past. Capacity is what is called „time-specific decision”: can the person make this decision when it needs to be made? (See MCA Code of Conduct, Chapter 4, for more information on capacity assessment.) Employees who support Johnny must assess his ability to understand the risk of walking on the highway. Perhaps, for example, he does not remember that traffic is going very fast and gets on the emergency lane, or he can remember that information, but he cannot use it to decide not to go on the highway. Before deciding that a person is incapable, it is important to take steps so that they can try to make the decision themselves. We identified 5 NHS mental health trusts where we saw effective ways to reduce the use of restrictive practices. We asked trusts about the work they do and what works well for their employees and the people who use their services.
The MCA establishes a checklist to consider when deciding what is in a person`s best interest. In 2015, the Mental Health Act Code of Conduct called on mental health services to reduce restrictive interventions. These practices include restraint, seclusion and prompt comfort. This also includes broader practices: for example, preventing a patient from accessing the outdoor space. The court also seeks to resolve any dispute if the person`s caregiver, health care worker or social worker disagree on what is in the person`s best interests, or if lawyers` views regarding property and welfare are conflicting. This includes decisions about everyday things like what to wear or what to buy for weekly shopping, or serious, life-changing decisions, like moving to a nursing home or undergoing major surgery. Any decision or action must always be in the best interest of the incompetent person. Thus, it may sometimes be necessary to choose an option that is not the least restrictive if that option is in the best interests of the person. „We strongly believe in engagement and distraction as a way to proactively assess and manage individuals, allowing us to adopt the least restrictive practices, reduce stigma and optimize the person`s experience.” So when it comes to small decisions, like wearing his football jersey, there`s no reason to believe Johnny can`t: he wears it when his team plays. Even if he were not able to, there is no risk associated with this choice, so he must be respected and praised: it is good to make decisions, and he does. In some cases, restrictions imposed on an incapable person may constitute a „deprivation of liberty”.
This must be assessed on a case-by-case basis. The Protection Court supervises the application of the Mental Capacity Act and deals with all matters, including serious financial and health matters, concerning persons who are unable to make their own decisions. The Mental Capacity Act (MCA) is designed to protect and empower people who may not have the mental capacity to make their own decisions about their care and treatment. It applies to persons 16 years of age and older. Perhaps Johnny`s grooming plan could include regular time to „look at the trucks safely” in his walks with staff; He could have an album of trucks or collect models. Finding the least restrictive way to satisfy a need can reveal amazing creativity, not only among employees, but also among service users and their families. And the joy of finding an imaginative solution that protects a person while respecting their rights is one of the true joys of working in adult social services. If there is more than one option, it is important to explore paths that are less restrictive or that give the most freedom to a person who does not have capacity. The safety and well-being of our customers is at the heart of everything we do. Therefore, by focusing on engagement and distraction with our customers, we can avoid restrictive practices.
This resource provides examples of good practices to reduce the use of restrictive practices. If someone is unable to make a decision and the decision must be made for them, the MCA states that the decision must be made in their best interest. Examples of people who may lack capacity are those who have: anything you do that might limit a person`s freedom of action should be the least restrictive option that meets the need – it`s not just about letting a vulnerable person do what they want, it`s about protecting them while restricting their rights and freedoms as little as possible. Someone may not be able to make some decisions (e.g., decide complex financial matters), but still has the ability to make other decisions (such as deciding what items to buy at the local store). Any restrictive intervention must be justified both ethically and legally. It should only be: If possible, part of the decision in the best interest might be to ask Johnny, when he is calm, what he wants employees to do when he becomes anxious; Part of this is consulting with your family to learn more about what might trigger this anxiety and how best to respond (see MCA`s Code of Conduct, Chapter 5, for more on making decisions in the best interest). The State of Care in Mental Health Services 2014-2017 revealed that there are differences in how employees engage in restrictive practices when responding to challenging behaviour. The report highlighted concerns that care for some patients is too restrictive. Deprivation of liberty guarantees (DoLS) previously only applied to people who were unable to do so while in a residential or hospital setting, but court decisions in 2014 extended it to any setting where a person is constantly monitored and controlled, unable to leave and unable to consent.
and funded by a government agency such as social services or health regulations. Working on the 6 Cs, which are care, compassion, competence, communication, courage and commitment, minimizes the risk of them adopting restrictive practices. The resource provides examples of best practices on: The law also states that we must do everything we can to improve a person`s ability to make their own decisions. In Johnny`s case, his ability to make certain decisions can be greatly improved: his family can give employees a lot of advice to help them understand how to do it and also help them recognize what makes him too anxious to listen properly. Employees learned to give them as much time as possible to make important or anxiety-provoking decisions and to repeat information in different ways, such as using images. A preliminary ruling must be valid and applicable in the present circumstances. If this is the case, it has the same effect as a decision by a competent person – health professionals must follow the decision. An EPO and an LPA must be registered.
A PLA can be registered at any time, but a personal wellness LPA only takes effect when the person has lost the ability to make their own decisions. If they decide that he is unable to make this decision safely, then in Johnny`s best interest, they will have to make a decision on how to plan when he wants to go on the highway. Before making a decision or acting on behalf of someone who is unable to do so, always ask yourself if you can do anything else that would be less detrimental to their fundamental rights and freedoms. But what is the „least restrictive practice” and why should we use it? First, let`s understand what restrictive practices are. When professionals talk about using the „least restrictive option” when working with service users who are believed to be incapable of making certain decisions, some may fear that this means they can do whatever they want, even if it puts them at risk.