Executive Functioning and Mental Capacity

Aims:

This one day programme aims to help practitioners in their work when assessing the mental capacity of the people we support – particularly where there may be issues and questions with regards to executive functioning. It will explore the assessment of capacity through the lens of the specifics of the Act in sections 1,2, and 3 underpinned by recent case law as well as research examining executive functioning, its presentation and effect on decision making.

Objectives:

This will be achieved via:

• Examining the Act with a specific focus on the first three of its sections to help practitioners understand the parameters of the powers of the act and to see where executive functioning sits within those descriptors.
  (This will cover case law examining the presumption of capacity and the interface with all the principles to set out the differences between decisional and executive capacity. It will consider through the examination of S.2, how the act defines a lack of capacity before leading on to the s.3 functional test.)
• Consideration of case law examining evidence of understanding and using and weighing up in particular.
  ( These are core issues when trying to determine executive and decisional capacity.)
• What do we mean by executive functioning and executive capacity? (Considering the fact that executive function has, in theory, no bearing on decisional capacity and therefore is not seen as part of the act however, practitioners are faced on a daily basis with issues and dilemmas provoked by situations where people can make decisions, but are unable to put those decisions into effect. This could be because of impaired memory, or impulsivity and a lack of self regulation and whether the latter 2 examples are as a result of impairments of, or disturbances in the mind or brain.)
• Exploring awareness at the interface of decisional and executive functioning (drawing on research examining the pyramidal scale of awareness to determine whether someone really understands the decision – i.e. are they aware that they may have impairments which might alter their memory or behaviours?)
• Considering the evidence practitioners need to consider when arguing that someone may or may not have either executive or decisional capacity and what else might effect someone’s ability to make decisions.

Outcomes:

By the end of the session, practitioners will have gained an understanding of their role when assessing decisional capacity and the interface with executive functioning and this will increase their confidence in claiming their judgements in assessments.