Insight & Capacity (Practicable Steps)

The second principle of the MCA concerns support for persons whose decision-making abilities may be impaired:

A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

 Mental Capacity Act (2005), sec. 1(3).

Where decision-making capacity is found to be absent due to impaired insight, consideration should be given as to whether practicable steps might be taken to support insight and thereby support the person’s ability to make a decision for themselves.  Suitable practicable steps may vary widely with the person and circumstances.  Simple steps such as improved rest, nutrition and hydration can impact upon cognitive functioning, and thereby support insight.  Insight can also be supported by taking steps to reduce anxiety, or simply by allowing the person more time to come to terms with a diagnosis.  Lack-of-insight is rarely an all-or-nothing matter, and a degree of doubt or uncertainty can provide a point of contact with a sympathetic clinician to explore alternative conceptualisations which may lead to a shared and acceptable treatment plan. However, this may take considerable time and effort from all concerned.  Insight is often held and sustained collectively, in the context of relationships with trusted friends, family members or supporters, and can sometimes be undermined by dysfunctional relationships.  Steps to support the person’s relationships can therefore serve to support insight and thereby to support capacity.

Insight & Capacity (Scales)