Capacity Assessment Guidance Document As per Section81 of

MentalHealthcare Act, 2017

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An Expert Committeeto prepare a quidance

As per Section 81 (1) of the document on Capacity Document

Mental Health

Mental Healthcare Act, 2017, the

Authority appointed an Chairman, Central

document tor medical Expert Committee to prepare a guidance procedures for practitioners and mental health

mental health assessing, when necessary or the professionals, Containing

capacity of persons to make

were appointed for

drafting the guidance

Authority members

care or treatment

decisions. Following Central

Dr. B.N. Gangadhar, Chairman of this Dr. Nimesh Desai

Dr.Rajesh Sagar Dr, Prashant Mishra

Dr. Gorav Gupta Ms. Rajeshwari lyer

Mr.Akileshwar Sahay

Mr. D.R. Sachadeva (invited)

document committee

The committee acknowledges the contribution of the development of the Capacity

following professionals in the Assessment Guidance Document

Dr. Jagadisha Thirthahali, Professor of Psychiatry,

Dr. Suresh Bada Math, Professor of NIMHANS, Bangalore

Psychiatry, NIMHANS, Bangalore Professor of Psychiatry, GMCH, Chandigarh

Dr. Nitin Gupta,

Dr. Naveen CKumar, Additional Professor of Psychiatry, NIMHANS, Bangalore

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Capacity Assessment as per Mental Healthcare Act, 2017 Overview

Capacity is the ability to make a particular decision, having understood the information relating to the decision at hand and appreciating the consequence of making or not making that decision. Capacity is not static, but dynamic in nature. People may have a condition or illness that affects their ability to make decisions. A lack of capacity may be temporary such as that caused by some illnesses or the influence of drugs or alcohol or mood / affective state. A person’s capacity may vary over time depending on the conditionor illness that the person experiences.

Aperson is presumed to have the capacity tomake a decision unless there are good reasons to doubt this presumption. In general, capacity is assessed with respect to a specific decision at a specific time. A person is entitled in law to make unwise or imprudent decisions, provided they have the capacity to make the decision. Supported decision-making involves doing everything possitble to maximise the opportunity for a person to makea decision for themselves. As per the MHA, 2017

Allpersons with mental illness shall have capacity to make mental healthcare or treatment decisions but may require varying levels of support from their nominated representative to make decisions. A person’s capacity should be assessed in

relation to a particular task or decision. Capacity cannot generaly be inferred from one task or decision to another.The person’s lack of capacity may be temporary, or fluctuating. Ifpossible, an assessment of capacity should be done when the person’s condition has improved. For example, if the person has a delirium, it is better to wait until this has resolved. In such patients with Delirium, Severe Manic Excitement,

Stupor,Alcohol and other substance use intoxication, Capacity Assessment may not be feasible, and they can be deemed to have “Obvious” lack of capacity and may be recorded as such. Finally, the capacity assessment is based on combination of relevant history, symptoms, behavior observation, mental status examination and diagnosis. It is aclinical judgement of aclinician.

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Guidance document is drafted as per the Section 81 of the MHA, 207/

81. (1) The

quidance document for medical practitioners and mental health professionals,

Central Authority shall appoint an Expert Committee to prepare a

containing procedures for assessing, the capacity of persons to make mental nedi care or treatment decisions.

(2) Every

capacity of aperson to make mental healthcare or treatment decisions, comply w n

medical practitioner and mental health professional shall, while assessing

the guidance document referred to in sub-section (1) and follow the proceoure specified therein.

This guidance document is only a guidance document and does not replace the legal advice. This document is not a structured or checklist instrument and only a

guidance document with provision for semi-structured assessment and documenting

the capacity assessment findings. The final decision of capacity is based on holistic assessment of behavioral observation, clinical findings, mental status examination,

diagnosis and capacity assessment as per the guidance document. Further it is the prerogative and the duty of the Mental Health Professional/Clinician to record the

clinical findings in details and/or elaboration of the same.

Mental Healthcare Act, 2017 articulates following regarding the Capacity to make mental healthcare and treatment decisions.

4. (1)Every person, including aperson with mental illness shall be deemed to bave capacity to make decisions regarding his mental healthcare or treatment if such person has ability to –

(a) understand the information that is relevant to take a decision on the treatment or admission or personal assistance;

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