Since 2017, we have commissioned several Safeguarding Adults Reviews (SARs) which have included practice concerns regarding mental capacity. Many of the SAR’s identified similar learning about mental capacity and the issues that practitioners face working in this complex area. This document is designed to support practitioners, it identifies the mental capacity issues identified in the SAR’s and also provides links to a number of resources around the area of concern.

We would like to thank James Codling (MCA/DoLS Learning and Development Team) of Cambridgeshire County Council, who has written this document and identified the resources contained within it.

MCA Themes arising from SARs

DateIssues Surrounding Mental Capacity
  • Lack of MCAs being undertaken
  • Professionals taking the mother’s view over the adult daughter’s view (daughter was the service user)
  • Not seeing the daughter alone
  • Lack of understanding of her lived experience
  • He was seen as a difficult man – as opposed to a man who’s behaviour was possibly a result of his
    care needs.
  • At times given his medication he would have lacked capacity – but was deemed by professionals as
    having capacity
  • Agencies such as housing not seeing undertaking an MC Assessment as their responsibility
  • Lack of MCA’s undertaken by agencies and confusion regarding whose role it was to undertake them
  • Lack of understanding of his lived experience
  • MC Assessments – No consideration of the impact of illness on capacity – little understanding around coercive control
  • Speaking to the husband and not the wife (adult with care and support needs) about her needs
  • MC Assessments not undertaken by agencies
  • Power of Attorney to son
  • Dementia
  • Not seeing the adult alone
  • Best Interests assessments not considered
  • Differing outcomes to MCA’s undertaken by different professionals
  • Dementia
  • Not speaking to the adult at risk
  • No discussion of power of attorney with family
  • MC Assessments not undertaken by agencies
Miss Y
  • MC Assessments not undertaken by agencies
  • Brian Injury + alcohol dependant – fluctuating capacity
  • When not drinking was deemed to have capacity
  • Links between alcohol + brain injury + MC not fully explored or understood
  • Complexity for professionals working with fluctuating capacity
  • Brian Injury + alcohol dependant – fluctuating capacity
  • When not drinking was deemed to have capacity
  • Links between alcohol + brain injury + MC not fully explored or understood
  • Complexity for professionals working with fluctuating capacity
  • Brain injury as a child
  • No MCA’s undertaken by professionals
  • No Best Interests assessments
  • Care home not sharing MCA / Best Interests assessments / DoLs

Safeguarding Adults and the Mental Capacity Act – Resources for different areas of concern

Area of concernWritten GuidanceWebinars
Risk and the MCASee Home – Capacity guide in particular The situation seems risky to me – Capacity Guide
Self-neglect and the

SCIE Self-neglect and SCIE Report 46: Self-neglect and adult safeguarding: findings from research, 2011, although pre-Care Act, it’s still an excellent resource.

Vile Bodies: Understanding the neglect of personal hygiene in a sterile society, Bates, 2021 (excellent book)

Working with People who Self-Neglect (

Managing hoarding and squalor – PMC ( (although Australian research I think it is great and helpful)

Court of Protection cases:

Keith’s story: a personal and touching film about hoarding (Birmingham Safeguarding Adults Board, 2016)
Hoarding and the

Relevant case law – AC and GC (Capacity: Hoarding: Best Interests) | 39 Essex Chambers (see also Hoarding and mental capacity (

Presentation slides on the topic are here Current thinking on hoarding behaviour (

Multi-agency Protocol for Working with People with Hoarding Behaviours | Cambridgeshire and Peterborough Safeguarding Partnership Board

Cambridgeshire Insight – Housing & Planning – Housing priorities – Existing homes – Hoarding

Hoarding disorder – NHS (

The Court Report with Tim Spencer-Lane: hoarding and the law transcript – Adults ( (not free, unless CCInform Adults member)

Alcohol addiction and the MCA

ARBD – Alcohol related brain damage (excellent resources)

How to use legal powers to safeguard highly vulnerable dependent drinkers | Alcohol Change UK

Breaking the link alcohol, cognition and homelessness- Prof Kenneth Wilson – YouTube

Alcohol Related Brain Damage and capacity – in conversation with Ken Wilson and Julia Lewis – Mental Capacity Law and Policy

ARBD Videos – ARBD

Suicide and the MCA

Mental capacity in practice part 1: how do we really assess capacity? | BJPsych Advances | Cambridge Core & Mental capacity in practice part 2: capacity and the suicidal patient | BJPsych Advances | Cambridge Core (need to be read together)

“If you are not a patient they like, then you have capacity”: Exploring Mental Health Patient and Survivor Experiences of being told “You Have the Capacity to End Your Life” (

The “you’ve got the capacity to choose to kill yourself” phenomenon, and what we can do about it | The Small Places (

Suicide and the (mis)use of capacity – in conversation with Dr Chloe Beale – Mental Capacity Law and Policy

Domestic abuse and the MCA

Reported SAR’s where MCA was not considered

Women who are experiencing domestic abuse are nearly three times as likely to develop mental illness (2019) and Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting (2018)) – Interesting papers when considering whether P might have an impairment or disturbance in the functioning of the mind or brain.

Relevant case law:

The Re BU [2021] EWCOP 54 case is a helpful illustration to explain when an application to the High Court for declarations and orders under its inherent jurisdiction may need to be considered in cases of domestic abuse.

In the decision of A County Council v LW & Anor [2020] EWCOP 50, the Court of Protection had to consider the capacity of LW in relation to the ‘interrelated decisions relating to contact with MG [the perpetrator], where she should live and the nature and extent of the care she requires’.

The 39 Essex Chambers ‘Mental Capacity Guidance Note Inherent Jurisdiction’

The person seems to say one thing and to do another (the MCA and executive functioning / dysfunction)

See the Home – Capacity guide in particular The person seems to say one thing and to do another – Capacity guide

When mental capacity assessments must delve beneath what people say to what they do – Community Care

Executive functioning grab sheet – Lancashire SAB

Brain Injury Needs Indicator (BINI) | The Disabilities Trust ( (NB: The BINI is a free tool developed by the Brain Injury Rehabilitation Trust (BIRT). The BINI has been designed to be used by social workers or other assessors during a social care assessment, for the purpose of finding out how well someone has recovered from their brain injury and to determine what social care support they might need. The BINI is referenced in the Care Act Guidance (point 6.43) as a tool that can be used as part of the assessment to help identify deficits of people with a suspected or diagnosed brain injury.)

Working with a person who may offend or is an offender and the MCA

When P is an Offender | 39 Essex Chambers

Medical Treatment and the MCA

See below (Essential general guidance) and:
A capacity masterclass from MacDonald J (and an updated capacity guide from us) – Mental Capacity Law and Policy (excellent CoP case which would help clinical professionals to think through capacity and medical treatment)

Decision making and consent – ethical guidance – GMC (

Mental capacity – ethical topic – GMC (

Mental Capacity Act toolkit (

Fluctuating capacity – making rights real and practical, not theoretical and illusory – Mental Capacity Law and Policy

See below (Essential general guidance) and: Informed consent | Hill Dickinson – YouTube

Informed consent – Claire Christopholus (Hill

General guidance:

  • Home – Capacity guide, which also covers:
    • The situation seems risky to me
    • I am finding it difficult to engage the person
    • The person’s capacity seems to fluctuate
    • The person seems to say one thing and to do another
    • The person seems to be under the influence of someone else

NB: They also have a Recording tool – Capacity guide and you can [Download a word doc of the recording tool here].