1. Action Learning

2. What are we doing? Aims Learning to apply the Mental Capacity Act in practice. Care Planning discussions Applying the Act to real life experiences Discussion to promote learning. Key words and prompts Small group work Videos Problem Solving

3. Welcome to Arnham Home for the Emotionally Troubled. Set in a hospital setting ( although this could be a nursing home) You have recently taken a job as a staff nurse. You are getting to know your patients and you are given Edna. There is a Care Programme Approach meeting organised, and the team are looking for a discharge plan.

4. Who are we meeting? Edna has been in hospital for 10 months. She came in with extremely poor self care , she had scabies and lice and evidence of malnutrition. She lives with her husband who is called Eddie. Her daughter (age 21) is called Jolene and her son ( age 26) is called Leroy. None of the family work at present. She had been cooking, cleaning and driving a car without supervision immediately prior to admission. Her family report on a holiday to Skegness just before coming into hospital, that she nearly ‘ killed them all’ while driving. Edna was aggressive towards her family and would chase them around the house, Jolene was so scared she had locked herself in the dining room until her brother had arrived home on one occasion. Edna likes cooking and looking after her family, she enjoys knitting and puzzles.

5. Who are we meeting? She recently scored 20 out of 30 on a Mini Mental State Examination. It showed that she was not orientated to time and place and that she has poor recall. Her speech is repetitive and she has extremely poor short term memory. Her family have been encouraged to take her home over the recent Christmas holidays and they did not come and pick her up on Christmas day, this upset her. They have only taken her home for 6 hours in 10 months. A recent Carer Assessment showed that the family are possibly able to care for her, but there is evidence of an unwillingness to take responsibility for her safety. He daughter says she is still scared of her mum despite reassurance that she is no longer aggressive. Her husband has diabetes and is unwell himself. Leroy says that he will help when he can, but is looking for a job. There is evidence of Jolene already being a carer for Eddie.

6. Who are we meeting? A recent Occupational Therapy assessment showed that Edna needs supervision to perform many tasks such as cooking ( she is fire risk because she thinks she can still cook). She is at risk of getting lost if she left the house on her own. She believes she can still drive a car and has no insight into her cognitive impairments, with regard to the risk she may pose to herself and others. Whenever you challenge her she states she will be alright and just wants to go home. Her self care remains poor in hospital, she requires prompting to bathe but she is resistive and tells the nursing staff she has already performed tasks when there is evidence she has not. Her aggression had diminished while she is in hospital and she is taking Aricept. She is an informal patient. Every ward round she asks to leave hospital and go home, she is ‘convinced’ to stay and quickly forgets she has asked to leave.

7. Autonomy Advocacy Mental Health Act 1983 Mental Capacity Act 2005 Risk Right to freedom of choice Team working and MDT Carer and service user involvement Capacity Statements Record keeping Key words to think about when watching the Video

8. Get together in small groups Talk about the video and ask yourselves: Should Edna be allowed to Leave Hospital and go home. What is in Edna’s best Interests? How to Advocate for Edna Think about Why? How? What? Where? When? and use the Key word terms to Prompt you to make a decision. Talk about your experiences of the Mental Health Act and the Mental Capacity act in the group.

9. So what did you decide? Mental Health Act 1983 Mental Capacity Act 2005

10. Decision Making Tree Mental Health Act Mental Capacity Act Capacity Statement Deprivation of Liberty ( DOLS) Care Planning

11. Checklist for Capacity Imca Advocacy

12. What happened next? Alternative Endings

13. What happened next? Alternative Endings

14. Alternative uses? Physical Conditions.

15. Conclusion