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The utility of the Montreal Cognitive Assessment as a mental capacity assessment tool for patients with a learning disability
- Authors:
- EDGE Daniel, et al
- Journal article citation:
- British Journal of Learning Disabilities, 44(3), 2016, p.240–246.
- Publisher:
- Wiley
Objective: To determine the psychometric properties of the Montreal Cognitive Assessment (MoCA) in patients with a learning disability and examine it's utility for conducting mental capacity assessment. Method: This study was a cross-sectional, instrument validation study in an inpatient hospital setting, located in the East of England. The sample consisted of two groups: (i) 31 consecutively admitted hospital patients and (ii) 10 multidisciplinary team members who served as a comparison group. The MoCA, a 12-item screen for mild cognitive impairment and the Dysexecutive Questionnaire (DEX), were used in this study. Item analysis was conducted by comparing item endorsement for all participants that had a learning disability utilising Difficulty and Discrimination Indices for each item on the MoCA. The authors examined the internal consistency of a revised scale derived from item analysis and used a one-way ANOVA to determine concurrent validity by comparing scores between two patient subgroups and the comparison group. Results: A 7-item scale, ‘MoCA-LD’ (alpha coefficient = 0.82) emerged from item analysis. A statistically significant negative correlation was observed between MoCA-LD and DEX (Pearson correlation = −0.66, P < 0.01). As expected, participants in the borderline category scored higher on MoCA-LD than those with mild learning disability, as did those with no learning disability (P < 0.001). Conclusion: The MoCA-LD has the potential to be a useful tool for mental capacity assessment in patients with a learning disability. (Edited publisher abstract)
The Adults with Incapacity Act in general hospitals and care homes: good practice guide
- Author:
- MENTAL WELFARE COMMISSION FOR SCOTLAND
- Publisher:
- Mental Welfare Commission for Scotland
- Publication year:
- 2017
- Pagination:
- 12
- Place of publication:
- Edinburgh
Updated practice guidance which sets out how decisions can be made for individuals in hospitals and care homes who are assessed not have capacity under The Adults with Incapacity (Scotland) Act 2000. The Act covers decisions made about welfare, medical treatment, property and finances. The legislation is often used to help people with mental health problems, learning disabilities or dementia. (Edited publisher abstract)
Briefing for providers on the Deprivation of Liberty Safeguards
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2014
- Pagination:
- 5
- Place of publication:
- London
An advice note from the Care Quality Commission on deciding whether arrangements made for the care and/or treatment of an individual who might lack capacity to consent to those arrangements amount to a deprivation of liberty. The note follows the ruling in the cases of P v Cheshire and Chester Council & Q v Surrey County Council. (Edited publisher abstract)
Deprivation of Liberty Safeguards: at a glance
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2011
- Pagination:
- 6
- Place of publication:
- London
This At a Glance summary provides key messages about the Deprivation of Liberty Safeguards (DoLS) and its use. It looks at what constitutes a deprivation of liberty, when deprivation of liberty can be used, the use of restraint and restrictions, how deprivation of liberty is authorised under the DoLS, and what happens in the case of urgent authorisations. [This version of Deprivation of Liberty Safeguards: at a glance has now been updated. The updated version was published in 2015]. (Edited publisher abstract)
Mental health, learning disability hospitals and Mental Health Act monitoring annual report 2018-2019
- Author:
- HEALTHCARE INSPECTORATE WALES
- Publisher:
- Healthcare Inspectorate Wales
- Publication year:
- 2020
- Pagination:
- 55
- Place of publication:
- Merthyr Tydfil
Annual report summarising the findings from inspections by Health Inspectorate Wales during 2018-2019. The report covers inspections of mental health and learning disability hospitals, community mental health services, and monitoring of the Mental Health Act. Key findings include positive feedback from patients regarding staff attitudes and their caring approach and a reduction in the number of complaints and concerns being raised. However, the report also identifies the need for improvement in the following areas: the environment of care, including issues affecting the privacy and dignity of patients; quality and safety of care; and the need for improved management and leadership in order to address staff resourcing and training issues. (Edited publisher abstract)
Deprivation of Liberty Safeguards: annual monitoring report for health and social care 2015-16
- Authors:
- CARE AND SOCIAL SERVICES INSPECTORATE WALES, HEALTHCARE INSPECTORATE WALES
- Publishers:
- Care and Social Services Inspectorate Wales, Healthcare Inspectorate Wales
- Publication year:
- 2017
- Pagination:
- 27
- Place of publication:
- Merthyr Tydfil
Seventh annual monitoring report on the operations of the Deprivation of Liberty Safeguards (DoLS) in Wales, which looks at whether additional resources and the revised guidance have helped in and improving the effectiveness of DoLS. The report analyses 2015/16 data from 22 local authorities and seven health boards which carry out the independent assessments of capacity and summarises the key findings. It found that there has been an increase of in the number of DoLS applications received by health boards and local authorities of over fifteen per cent from 10,681 applications 2014/15 to 12,298 in 2015/16. It also identifies an increase in the number of urgent applications. The increases of urgent applications are also resulting in delays in processing applications, carrying out assessments, and low levels of reviews. It concludes that the increasing numbers of applications have meant that the provision of additional resources and improved operating practices have had only a limited impact in improving the operation of the DoLS system. (Edited publisher abstract)
Monitoring the Deprivation of Liberty Safeguards in 2014/15
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2015
- Pagination:
- 32
- Place of publication:
- Newcastle upon Tyne
This is the fifth annual monitoring report on the implementation of the Deprivation of Liberty Safeguards. The report focuses on the impact on outcomes for people who lack mental capacity and may be deprived of their liberty, and highlights CQC actions and recommendations for improvement. The report draws on a range of sources, including analysis of a sample of 214 inspection reports of hospitals and care homes inspected in 2014/15 and data on Deprivation of Liberty Safeguards notifications received by CQC in 2014/15. Short case studies and good practice examples are included within the report. Key findings show there has been a tenfold rise in Deprivation of Liberty Safeguards applications from 13,715 in the year ending March 2014 to 137,540 by March 2015 which has also resulted in a backlog in local authority processing of applications. Evidence from CQC inspections also found that providers' use of the Deprivation of Liberty Safeguards was variable in relation to levels of staff training and awareness and the existence and implementation of policies and processes. Examples where provides may be unlawfully depriving people of their liberty were also identified. (Edited publisher abstract)
Not properly authorised: unannounced visits to people receiving treatment under part five of the Adults with Incapacity Act
- Author:
- MENTAL WELFARE COMMISSION FOR SCOTLAND
- Publisher:
- Mental Welfare Commission for Scotland
- Publication year:
- 2012
- Pagination:
- 14p.
- Place of publication:
- Edinburgh
The Adults with Incapacity (Scotland) Act 2000 (The Act) sets out the framework for regulating medical treatment or research for people who may lack capacity to consent. Previous visits to care homes and hospitals found that legal safeguards under the Act for medication and other interventions were not properly observed and therefore people who lacked capacity to consent were not receiving treatment in line with the law. This report details a series of unannounced visits to 90 care homes and hospitals and examined 519 individual care files, an average of about six per visit. Of the 519 files examined in detail, 467 people had a completed Section 47 certificate, around 90% of those who were identified by staff as lacking capacity to consent. The majority of the individuals whose files were examined, around 70%, were identified as having dementia. Around 13% had a learning disability, 7% had a mental illness, and around 5% had an acquired brain injury. A further 5% had alcohol related brain damage. Overall, there were concerns in around 20% of cases.
The use of the Mental Capacity Act among hospital patients: findings from a case study of one Acute Hospital Trust in England
- Authors:
- PHAIR Lynne, MANTHORPE Jill
- Journal article citation:
- Journal of Adult Protection, 14(6), 2012, pp.259-270.
- Publisher:
- Emerald
This paper presents findings from a review of hospital policies and practices in one NHS Trust in England. The focus of the review was hospital staff policy and practice in safeguarding the rights of vulnerable patients. A sample of 42 staff members was surveyed to investigate their knowledge of the Mental Capacity Act 2005 in 2010. Analysis revealed limited confidence and knowledge about the Mental Capacity Act 2005 and uncertainties about its relevance to clinical practice. In relation to safeguarding, there was limited realisation of the potential of the Act to uphold the rights of patients lacking capacity and staff responsibilities. MCA training had not made a great impression; hospital policies were inconsistent and lacked coherence. The authors concluded that the findings of this case study may be applicable to other hospitals and to other providers of health and social care services. The relevance of the MCA could be highlighted and used on several induction and training programmes. The study identifies features of policy and practice that could be investigated in other organisations.
The Deprivation of Liberty Safeguards part 4: challenging authorisation
- Authors:
- PEARCE Nasreen, JACKSON Sue
- Journal article citation:
- Family Law, 42, June 2012, pp.695-699.
- Publisher:
- Jordan
The framework introduced by amendments in 2009 to the Mental Capacity Act 2005 provides a regime whereby deprivation of liberty can be authorised by the state for people living in hospitals and care homes who lack capacity to consent to their living arrangements. This article, which is one of a series, describes and discusses the two routes for challenging the granting of authorisations. It looks first at review by the supervisory body, covering monitoring, review and procedure. It then looks at review by the Court of Protection, covering powers of the Court, procedure, the hearing, publicity, costs and funding, and case law (including a discussion of three case examples).