Mental capacity assessment and engagement

How to assess mental capacity and what to do if someone does not want to engage with the assessment

I attended a webinar with Nelson’s Solicitors this week. We decided that I would comment on the following questions

  • When capacity to make a specific decision is in issue, how do you test P?
  • When P is unwilling to communicate, what strategies do you have to try and break the deadlock?

As you can see in the image (see link here Scan post it notes ) I had lots of notes and planned my response.

What does P mean?

Firstly let me explain, in legal terms the ‘P’ stands for person in question or person being assessed.

Mental Capacity Assessment process

When doing a mental capacity assessment it is important to establish whether there is an impairment or problem with the brain, which may affect their ability to make decisions, such as dementia or brain injury. We also consider the history of the person and their current circumstances.

With the particular decision (for example financial decisions)  we need to establish whether the person can:

UNDERSTAND: We check understanding by asking a number of questions related to the matter. Such as where do you work? Sources of income, details of any debt, what bills do you have? Where do you bank? I also show most people objects to establish is they understand their uses. Such as money, till receipts, or a purse.


We check whether they can retain information throughout the assessment by providing information and check understanding and memory. I ask questions to check long and short term memory, as well as asking if they have noticed any problems themselves. I sometimes administer specific cognitive testing such as the Addenbrook’s Cognitive Examination (see link here)


This is more tricky to assess as people can often understand  but cannot use this information to make an informed decision. I would always check how people use information by asking other people how they manage information in real time. Consider how much support someone requires, whether they are in any debt or have problems managing themselves. This part of the assessment involves establishing whether there is evidence that a person can comprehend and rationalise information to make a decision.


Being able to reliably communicate a decision by any means is important. I have known people to use sign language, and writing information down. 

What to do if someone does not want to engage in assessment

To answer the question, to describe what I do when someone does not want to be assessed. Firstly I try to gather as much information as I can before the assessment date, I aways try to build rapport as soon as possible by reading  body language and ensure they feel listened to. I tend to approach every assessment differently depending on the person’s circumstances, but I always give respect and space, I do not behave or act as an expert.  I am always interested in their life and ask inquisitive questions. If the person does not want to engage, I will leave it and arrange to meet another day, and consider the location, environment and time of day.

I have added the link for a previous blog on working with vulnerable and young people

Guiding principles when working with vulnerable adults & young people

If you want to know more give me a call on 07734393918 or contact us via the website

Thank you for reading