Mental Capacity Assessments
What Happens During a Mental Capacity Assessment?
A plain English guide to the appointment itself, for the person being assessed and the people supporting them
A structured, supportive conversation, not a test to pass or fail
During a mental capacity assessment the assessor sits with the person and talks with them about one specific decision. They explain who they are and why they are there, check how the person communicates best, and then explore whether the person can understand, retain, use or weigh the relevant information and communicate their choice. It is a conversation, not an examination, and the person is given every practicable support to make the decision for themselves.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
Families often tell us the word assessment is the frightening part. It suggests an exam, a pass mark and the possibility of failing. A mental capacity assessment is nothing of the sort. Under the Mental Capacity Act 2005 every adult is presumed to have capacity, and the assessment starts from that presumption, as opposed to starting from a diagnosis or a label.
The conversation is about one specific decision at one specific time, whether that is selling a home, making a Will, granting a Lasting Power of Attorney or managing money. Knowing what will actually happen on the day helps the person arrive relaxed, and a relaxed person is far better placed to show what they can do.
The kinds of questions the assessor may ask
The questions are always anchored to the specific decision. Depending on what is being assessed, the assessor may explore:
- What the decision is, in the person's own words, and why it needs to be made now
- The options available and what each would mean for the person day to day
- The benefits, risks and consequences of each option, including deciding nothing at all
- For financial decisions, the person's own picture of their money, property and outgoings
- For a Will, who the person would like to benefit and a broad sense of what they own
- Whether anyone has offered a view on the decision and what the person makes of it
How to help on the day
Families and supporters make the biggest difference before the conversation starts:
- Keep the appointment low key. It is a conversation, not an interview panel.
- Have glasses, hearing aids and any communication aids to hand.
- Choose the time of day when the person is usually at their best, and tell us if that changes.
- Have paperwork relevant to the decision available if asked, such as financial statements or a draft Will.
- Resist the urge to answer for the person. The assessor needs to hear the person's own understanding, and prompting can undermine the assessment rather than help it.
- Share anything that helps beforehand: routines, communication preferences, good days and bad days.
What a good assessment should never feel like
- A memory test or a general knowledge quiz
- A pass or fail exam with trick questions
- A rushed conversation squeezed around a form
- A judgement on whether the decision is sensible, because the Act protects the right to make what others may see as unwise decisions
- A conclusion based on a diagnosis, age or appearance alone
- A conversation the person leaves without knowing what happens next
- A memory test or a general knowledge quiz
- A pass or fail exam with trick questions
- A rushed conversation squeezed around a form
- A judgement on whether the decision is sensible, because the Act protects the right to make what others may see as unwise decisions
- A conclusion based on a diagnosis, age or appearance alone
- A conversation the person leaves without knowing what happens next
The appointment, step by step
1. Introductions and purpose
The assessor explains who they are, who has asked for the assessment and what decision is being looked at. The person can ask anything they like before the conversation moves on.
2. Settling in
The conversation usually begins gently, with everyday topics that help the person relax and help the assessor understand how they communicate. There are no trick questions at any stage.
3. Talking about the decision
The assessor explains the decision and the information relevant to it, including the options available and their consequences. If something is unclear it is explained again in a different way, because the assessment is only fair if the person has genuinely been given the information they need.
4. Exploring the legal test
Through the conversation the assessor considers the 4 functional elements of the Mental Capacity Act 2005: whether the person can understand the relevant information, retain it long enough to decide, use or weigh it in reaching their decision, and communicate their choice by any means. Retention does not mean a perfect memory, and the person can use notes, prompts or aids.
5. Support throughout
Breaks are taken whenever they help. Questions are asked in plain language, topics are revisited rather than rushed and the pace is set by the person, not the paperwork.
6. Closing the conversation
Before leaving, the assessor explains what happens next and when, and the person and their family can raise anything that is worrying them.
7. After the appointment
The assessor writes the report, setting out the decision assessed, the evidence considered, the support provided and the reasoning behind the conclusion, including how any impairment affects the specific decision. Every report is peer reviewed before it is released, and our standard turnaround is 5 working days.
How Nellie Supports approaches the appointment
Nellie Supports is a social work led multidisciplinary specialist practice working across England and Wales, operating through a permanent, full-time employed team that has completed more than 11,000 assessments. Our assessors are registered professionals whose everyday work is decision-specific capacity assessment, including complex, disputed and court-facing matters.
Every report is peer reviewed before release, and where the report may be relied upon as evidence it is written with CPR Part 35 duties in mind from the outset. The reader sees not just a conclusion but the reasoning behind it: the decision assessed, the support provided and how any impairment affects the person's ability to make that specific decision.
Frequently Asked Questions
How long does the appointment take?
It varies with the person and the decision. The assessor takes the time the person needs, with breaks where they help. A fair assessment is never rushed.
Can family stay in the room?
Family are welcome to help the person settle, and the assessor will usually spend part of the conversation with the person alone so the answers are clearly their own. This protects the person and the reliability of the assessment.
What if the person has good days and bad days?
Capacity is time-specific, so tell us. We arrange the appointment for the person's best window, and any fluctuation is explored and recorded in the report rather than ignored.
Will the assessor test their memory?
The legal test is about the specific decision, not memory in general. Structured cognitive tools are used only where they are clinically relevant, and they never replace the Mental Capacity Act 2005 test.
What happens if the assessor concludes the person lacks capacity?
The report explains the conclusion with evidence, and it applies to that decision only, as opposed to being a judgement about the person in general. What follows depends on the decision, and may include best interests decision-making or an application to the Court of Protection, with the report written to support whichever route is needed.
When will we receive the report?
Our standard turnaround is 5 working days, and every report is peer reviewed before it is released.
This guide is general information about mental capacity assessment in England and Wales, not legal advice, and does not create a professional relationship. Nellie Supports provides independent social work assessment, evidence and advocacy support. We do not provide regulated legal advice, and where a legal remedy is needed we will say so and support your solicitor's work.