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Original poster

Can a capacity assessment for medical reasons ever be done without the patients knowledge?

124 replies

autonomyagain · 27/04/2023 15:54

Or would the patient know as they’d have to attend for tests etc?

I assume it would be documented in notes too?

Can these ever be done in a less formal way by a gp just about one issue or is it always a formal assessment that then removes autonomy for everything not just one thing ?

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x2boys · 27/04/2023 15:58

It would depend on circumstances,if a health care professionals was doing a capacity assessment for some who has learning disabilities or dementia for example they might not understand they were being assesed ,patients can be deemed to have capacity in some area but not others.

Original poster
autonomyagain · 27/04/2023 16:00

x2boys · 27/04/2023 15:58

It would depend on circumstances,if a health care professionals was doing a capacity assessment for some who has learning disabilities or dementia for example they might not understand they were being assesed ,patients can be deemed to have capacity in some area but not others.

The only health issue would have been previous depression 4 years prior and treated with AD for 2 years then stopped and no further MH issues

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Original poster
autonomyagain · 27/04/2023 16:02

So a 2 year period with no AD right before this incident (was a child when diagnosed with depression , no LD etc) but 18 at the time I’m querying was something done.

I thought I’d ask here before I take a more formal route to actually find out as google isn’t really helping and I hoped someone may know

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Original poster
autonomyagain · 27/04/2023 16:03

The year was 2000 if relevant . I’ve tried to look up guidelines for that time and not really found what I’m looking for

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x2boys · 27/04/2023 16:19

The mental.capacity act didn't come into force until 2005, were they assessed under the mental.health act ?( Although that would normally be two Drs assessing and a social worker making the the application)

Original poster
autonomyagain · 27/04/2023 16:21

x2boys · 27/04/2023 16:19

The mental.capacity act didn't come into force until 2005, were they assessed under the mental.health act ?( Although that would normally be two Drs assessing and a social worker making the the application)

As far as I’m aware there was no assessment at all done (it was me). There’s nothing in notes to say I was assessed but multiple documents showing another person was given authority over a medical decision.

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Original poster
autonomyagain · 27/04/2023 16:22

I just wondered if there was something in place at that time allowing a single gp to override capacity for just that occasion

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OneFrenchEgg · 27/04/2023 16:32

Can these ever be done in a less formal way by a gp just about one issue or is it always a formal assessment that then removes autonomy for everything not just one thing ?

The 2005 Mental Capacity Act comes after your period , as a pp says. But that doesn't remove capacity/autonomy for everything - it's decision and situation specific. It's also not always 'formal' if eg it's a daily type thing.

As the pp says, the Mental Health Act is 1983 - this would have seen you admitted to hospital though if you say all autonomy was removed?

Mykingdomforanap · 27/04/2023 16:34

Mental capacity act England 2005 and adults with incapacity act Scotland 2000 cleared up a lot of this as it was murky.

Original poster
autonomyagain · 27/04/2023 16:45

OneFrenchEgg · 27/04/2023 16:32

Can these ever be done in a less formal way by a gp just about one issue or is it always a formal assessment that then removes autonomy for everything not just one thing ?

The 2005 Mental Capacity Act comes after your period , as a pp says. But that doesn't remove capacity/autonomy for everything - it's decision and situation specific. It's also not always 'formal' if eg it's a daily type thing.

As the pp says, the Mental Health Act is 1983 - this would have seen you admitted to hospital though if you say all autonomy was removed?

The only hospital admission was for a day case procedure (this is what I was not allowed to make a decision on) hence why I’m was confused and wondered could something have been done without any formal assessment and just on my parents insistence - but I was 18 and I had no assessments I was aware of at all. It was a long time ago and I’m still confused to this day.

I’ve posted about it before a couple of years ago and I just can’t get answers and it’s on my mind a lot . My medical notes give me nothing except clearly showing my wishes were disregarded in favour of my mothers and it was documented eg ‘autonomyagain clearly stated she does not want X . Her mother is insisted the procedure goes ahead. She will be sent home and told to reconsider and rebooked for nest week as per mothers wishes ‘

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OneFrenchEgg · 27/04/2023 16:45

So, I found a green paper (consultation) which led to the mental capacity act called 'who decides? Making decisions for mentally incapacitated adults. This is 1997

wellcomecollection.org/works/y423389w/items?canvas=4

Original poster
autonomyagain · 27/04/2023 16:46

I did have a history of some depression (which was medicated aged 14-16) would this have been sufficient to then do this ?

I should let it go but I can’t get it out of my head.

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Original poster
autonomyagain · 27/04/2023 16:46

OneFrenchEgg · 27/04/2023 16:45

So, I found a green paper (consultation) which led to the mental capacity act called 'who decides? Making decisions for mentally incapacitated adults. This is 1997

wellcomecollection.org/works/y423389w/items?canvas=4

Thank you I’ll read that now

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OneFrenchEgg · 27/04/2023 16:47

This paragraph about the consultation indicates there wasn't a framework and people were let down. I linked it - maybe have a read and see if anything rings a bell or makes sense?

Can a capacity assessment for medical reasons ever be done without the patients knowledge?
Original poster
autonomyagain · 27/04/2023 16:53

Interestingly a lot of the letters contained info written as if I was still 14-16 and mentioning issues with school and college and by 18 I had been off AD for 2 years and had a full time job so a very misleading referral was sent to the hospital which started things off-I feel the problem originated at the gp but I can’t see how they had that much power ?

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tatyr · 27/04/2023 17:22

Do you feel you were treated/tested against your consent?
It must be very hard to pick apart something which happened so long ago, where no answers are likely to be forthcoming.

Acheybreakyhead · 27/04/2023 17:25

Teenagers won't be tested the same as an adult when it comes to accessing medical care, it's determined whether you're gillick competent or not. That is under the age of 16.

Acheybreakyhead · 27/04/2023 17:27

A formal capacity assessment is a big deal and should be done around a specific concern (you can be capable of choosing your dinner but not able to manage money for instance) and always give you the chance to prove you are capable. It's not something a professional can determine as an individual either.

Original poster
autonomyagain · 27/04/2023 17:32

tatyr · 27/04/2023 17:22

Do you feel you were treated/tested against your consent?
It must be very hard to pick apart something which happened so long ago, where no answers are likely to be forthcoming.

Absolutely yes. For years I felt upset as I knew I’d kept refusing but it felt like nobody was listening to me .
When I got my notes that was one piece of the puzzle as I saw that actually they WERE listening. What I said was recorded but overruled each time and it was clearly stated how my mothers wishes were opposing mine and hers took priority.

I can’t change the past and I’m working on this but I was desperate to find out the process by which this happened and I can’t find anything.

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AnnaMagnani · 27/04/2023 17:34

Nobody was doing capacity assessments in 2000 as the Mental Capacity Act didn't exist.

My concern is that you were 18 and not giving consent yourself. As an adult the decision should have been up to you.

Gillick competence existed for children but you were older than that so it didn't apply.

Original poster
autonomyagain · 27/04/2023 17:34

Acheybreakyhead · 27/04/2023 17:25

Teenagers won't be tested the same as an adult when it comes to accessing medical care, it's determined whether you're gillick competent or not. That is under the age of 16.

Perhaps there was a grey area back then ? I was 18 though so legally an adult ?

I don’t think I’m ever going to get answers unfortunately. I’m going round in circles over it when I need to move forward. I just feel so frustrated and more than anything, violated.

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Original poster
autonomyagain · 27/04/2023 17:37

AnnaMagnani · 27/04/2023 17:34

Nobody was doing capacity assessments in 2000 as the Mental Capacity Act didn't exist.

My concern is that you were 18 and not giving consent yourself. As an adult the decision should have been up to you.

Gillick competence existed for children but you were older than that so it didn't apply.

Looking at my medical notes it seems to be that my mother and the GP decided on a course of action that was then implemented. For a very long time I actually blamed myself thinking maybe I hadn’t made myself clear enough even though deep done I knew I had. To see it all written down actually helped me as I thought ‘ok - I really did get my point across it was just never going to be respected’ so I stopped blaming myself.

I’ve asked my mother in the past. She refuses to discuss it. Even when I told her I had the notes she will not say a word or answer any questions

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Acheybreakyhead · 27/04/2023 17:41

With all due respect this is probably something you may be better off discussing for a trained counsellor. I know with maternity records you can have a debrief from a midwife I wonder if you could do likewise with the mental health team or GP and go through your notes to understand better?

Mykingdomforanap · 27/04/2023 17:47

OneFrenchEgg · 27/04/2023 16:47

This paragraph about the consultation indicates there wasn't a framework and people were let down. I linked it - maybe have a read and see if anything rings a bell or makes sense?

That’s what I meant by murky - things were a mess understand it (before my time) and a law was needed to clarify things as because situations where, for example, an adult was consenting for another adult were happening.

Original poster
autonomyagain · 27/04/2023 17:57

Acheybreakyhead · 27/04/2023 17:41

With all due respect this is probably something you may be better off discussing for a trained counsellor. I know with maternity records you can have a debrief from a midwife I wonder if you could do likewise with the mental health team or GP and go through your notes to understand better?

Yes I’ve been having counselling , I just keep going back to this and wondering did I somehow have an assessment I wasn’t aware of but I can see there wasn’t anything in place at that time to have done that. It’s just really frustrating me

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