The Mental Capcity Act 2005 can apply to people who are alcohol dependent.  However,  research identified that, at times, these dependent drinkers may be wrongly viewed as having mental capacity, which places them at risk. This can relate to the mistaken view, that these people are making a ‘lifestyle choice’.

The Act is clear: “A lack of capacity cannot be established merely by reference to... a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about his capacity.”

The question, therefore, is under what circumstances do chronic, highly vulnerable, dependent drinkers lack capacity to make key decisions about their care, treatment or living conditions?
The Mental Capacity Act 2005  does not, as is sometimes suggested, give a right to make
unwise decisions; however, it requires professionals to demonstrate that the person does
not have capacity to take a decision at a particular point in time.

For more information you can read A Quick Guide to.....Substance Misuse and Self Neglect

Alcohol and capacity

There are significant safeguarding risks, to adults who use substances for themselves and others.
Without action, these people and those around them can experience serious dangers, including neglect, abuse, and untimely deaths. This group of people often requires more
robust support, by using legal powers. Practitioners  need to be aware of the legal frameworks and how the legislation, including the MCA can be applied to improve outcomes.  Alcohol Change UK has published guidance for practitioners working with adults who use alcohol to support practice -

How to use legal powers to safeguard highly vulnerable dependent drinkers in England and Wales

Alcohol related brain damage and capacity

Watch this 'in conversation' recording with Alex Ruck Keene where he discusses the issue of alcohol related brain damage and the impact this can have on capacity.  They also discuss when and why thinking about capacity to manage alcohol is actually useful in the abstract.

Learning from Safeguarding Adult Reviews locally and nationally indicate that in some cases professionals can be quick to assume capacity, respect autonomy assuming that it is a “it’s a lifestyle choice”.  However, learning from SARs often indicates a lack of professional curiosity and that mental capacity and risk assessments are not robust.

You can read the learning from recently published local SARs on CSAB website.

Practice with people who self neglect is more effective when practitioners demonstrate professional curiosity and keep constantly in view the question of the individuals mental capacity to make self-care decisions.  You can view a presentation  from Professor Michael Preston-Shoot at our recent Safeguarding Conference on 8^th March 2023.  The presentation uses real stories and experiences to remind practitioners of the need to consider and assess capacity when working with adults who self neglect and the importance of avoiding what is often referred to as a ‘lifestyle choice’.

For more information about self-neglect you can watch a 'lunch & learn' recording and also refer to CSAB self-neglect guidance.

People have the right to make decisions that others might think are unwise and should not automatically be labelled as lacking the capacity to make a decision.  SCIE have published a  short film depicting scenes in a domestic setting between an older man and his domiciliary care worker.

The film introduces the principles of the Mental Capacity Act in relation to a financial decision and portrays Raymond, a man in his 80s and recently diagnosed with dementia, and Wendy his paid care worker. The setting is Raymond’s flat. Wendy visits daily to provide Raymond with practical support to manage at home. The context of the drama is whether Raymond has capacity to make a decision about spending 50 pounds on lottery tickets.

Watch the film here.

CSAB are sharing learning resources for practitioners for personal development and can also be useful during team meetings and/or supervision sessions.

CSAB MCA 'learning zone'

You can access a range of resources here

Social Care Institute for Excellence

SCIE have produced a whole series of short learning videos for practitioners based on the 5 principles of the MCA.  Watch here 

MCA easy read guide

You can access an MCA easy read guide and summary here

Legal advice and guidance

39 Essex Street Chambers has developed an unrivalled set of resources for those seeking to apply and understand the Mental Capacity Act 2005, as well as to understand the place of mental capacity within the law more generally.  There is a dedicated MCA section of the website which gathers together sets of resources which you can access.

Edge Training Ltd resources

There are a series of briefings and information sheets intended to support practitioners working with the MCA.  This inlcudes case law updates, guidance and templates find out more here