Given the prevalence of cognitive deficits within brain injury the range of deficits an individual can experience has an important influence on their ability to make decisions in relation to daily activity. For example, an individual experiencing executive dysfunction may experience problems with abstract thinking and emotional regulation, which has clear implications for limited ability to engage in complex decision making such as personal care or financial management.
Cognitive impairment may have an impact on the individual’s awareness and understanding of their current circumstances. Furthermore this may have an impact on ability to understand and engage with therapeutic interventions.
A range of legislation exists in the UK that can be used to manage difficulties arising from cognitive impairment. Given the geographical anomalies within the law systems of the UK separate legislation exists in England and Wales, and Scotland:
The Mental Capacity Act (England and Wales)
Adults with Incapacity (Scotland) Act 2000
Adult Support and Protection (Scotland) Act 2007
A range of guidance is available for each of the aforementioned acts which is summarised here in terms of assessment. It is suggested the following areas are considered within assessment based around the Adults with Incapacity (Scotland) Act 2000; Perception, understanding, logical thinking, memory, motivation, planning, reasoning, suggestibility, emotional disorder, thought disorder and communication problems. All of these are included in a comprehensive neuropsychological assessment. Further to this the following points are:
- Make sure the capacity question is specific
- Consider evidence of impaired judgement prior to admission
- Use vignettes to support exploration of the particular decision to be made
If you have a client that requires a capacity assessment please contact Alba Psychology.