I have been thinking about some of the complex issues related to assessing someone in relation to accepting treatment or support for hoarding under the UK Mental Capacity Act (MCA) 2005 particularly given that it is not a diagnosable disorder.
I contacted a couple of Mental Capacity Act leads in my work area to ask the following questions;
1) If hoarding is not diagnosable condition, should it still be be regarded as a "Disturbance of functioning of the mind or brain " which would warrent assessment under the MCA. Plus if hoarding does become diagnosable (as proposed for the DSM V) would that change assessment under the MCA?
Both respondents felt that someone with hoarding behaviours could be assessed under the MCA as do other conditions which do not have a diagnosis e.g cognitive impairment without a diagnosis of dementia. Although the code of practice does state that you need clear proof of this disturbance and its impact on the ability to make a specific decision to establish that there something affecting the way the mind is working and not just a case of "eccentricity".
I'm guessing from this an example would be a strong fear of wastage resulting in a refusal to discard seemingly worthless items/rotting food and associated distress which. may count as an example of an impairment of the brain- but it sounds like it requires careful assessment and documentation.
It was felt by both respondents that making hoarding diagnosable would help to clarify assessment under the MCA as I imagine staff working in acute settings such as medical wards would not necessarily have the time or training to identify the specific impairment.
My second question related to the tricky area of weighing up the pros and cons of a particular decision in relation to risk.
2) In some situations I have come across, although there are concerns about potential risk due to excess clutter, no adverse event has occurred and the client demonstrates some awareness of risk eg "I don't smoke and I'm careful when I walk around" or "If I ever have an accident I will get help". I asked whether that would demonstrate some ability to weigh up the pros and cons under the MCA.
Both respondents thought that in that type of situation, it could be argued that the person does have capacity to weigh up the pros and cons- although it is very important to be clear about each risk and how likely it would occur.In some cases the evidence of imminent risk is so overwhelming - e.g events such as fires,infestations , falls have occurred and if the client denies this event has or will occur again, it could be argued that they do not have capacity make a decision about action to reduce risk.
Both respondents felt it was a very interesting and complex area and is not straight forward. It would be great to hear about any thoughts , experiences , questions regarding this complex area of practice.
I contacted a couple of Mental Capacity Act leads in my work area to ask the following questions;
1) If hoarding is not diagnosable condition, should it still be be regarded as a "Disturbance of functioning of the mind or brain " which would warrent assessment under the MCA. Plus if hoarding does become diagnosable (as proposed for the DSM V) would that change assessment under the MCA?
Both respondents felt that someone with hoarding behaviours could be assessed under the MCA as do other conditions which do not have a diagnosis e.g cognitive impairment without a diagnosis of dementia. Although the code of practice does state that you need clear proof of this disturbance and its impact on the ability to make a specific decision to establish that there something affecting the way the mind is working and not just a case of "eccentricity".
I'm guessing from this an example would be a strong fear of wastage resulting in a refusal to discard seemingly worthless items/rotting food and associated distress which. may count as an example of an impairment of the brain- but it sounds like it requires careful assessment and documentation.
It was felt by both respondents that making hoarding diagnosable would help to clarify assessment under the MCA as I imagine staff working in acute settings such as medical wards would not necessarily have the time or training to identify the specific impairment.
My second question related to the tricky area of weighing up the pros and cons of a particular decision in relation to risk.
2) In some situations I have come across, although there are concerns about potential risk due to excess clutter, no adverse event has occurred and the client demonstrates some awareness of risk eg "I don't smoke and I'm careful when I walk around" or "If I ever have an accident I will get help". I asked whether that would demonstrate some ability to weigh up the pros and cons under the MCA.
Both respondents thought that in that type of situation, it could be argued that the person does have capacity to weigh up the pros and cons- although it is very important to be clear about each risk and how likely it would occur.In some cases the evidence of imminent risk is so overwhelming - e.g events such as fires,infestations , falls have occurred and if the client denies this event has or will occur again, it could be argued that they do not have capacity make a decision about action to reduce risk.
Both respondents felt it was a very interesting and complex area and is not straight forward. It would be great to hear about any thoughts , experiences , questions regarding this complex area of practice.
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