GUIDES
Prepare by confirming the decision, sharing relevant documents and explaining how the person communicates and when they are most comfortable. Arrange appropriate support and a quiet setting; the person does not need to rehearse answers.
Author: Nellie Supports Ltd
Publication Date: 15/05/2026
NHS (2023) Mental Capacity Act. Available at: https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/
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Prepare by confirming the decision, sharing relevant documents and explaining how the person communicates and when they are most comfortable. Arrange appropriate support and a quiet setting; the person does not need to rehearse answers. This guide covers the relevant evidence, support, process and limits in England and Wales.
Preparing for a mental capacity assessment mostly means gathering the right information and helping the person be at their best. Before the appointment, confirm the specific decision being assessed, collect relevant documents such as medical records, care notes and anything showing recent decision-making, and tell the assessor about communication needs, the best time of day and anything that helps the person engage. The assessment itself is a structured, supportive conversation, not a test to pass or fail, and nothing about it needs rehearsing. This guide explains what to prepare, what to expect on the day and how the report that follows is put together.
Confirm the decision and intended use before collecting documents. Tell the assessor about the person’s circumstances and what helps them understand and communicate. The person should receive an accessible explanation of the purpose and have a genuine opportunity to participate.
Start by presuming capacity and taking all practicable steps to support the person. An unwise decision does not by itself establish incapacity. For this decision at this time, assess whether the person can understand and retain the relevant information, use or weigh it and communicate a decision by any means. If an ability is absent, explain whether an impairment of, or disturbance in the functioning of, the mind or brain causes that inability. Short retention is enough if it enables the decision.
For this topic, relevant information commonly includes the decision to be assessed, why capacity is in doubt, the relevant information, communication needs, practical support, evidence sources, risks, urgency and intended use of the report. The relevant information should be tailored to the person’s actual circumstances. It should not be copied from a generic template if the person’s options, risks or legal context are different.
The assessment is stronger when the evidence is organised before the conclusion is reached. Useful evidence may include the letter of instruction, medical and care records, legal documents, professional notes, family background, communication information and examples of recent decision-making. Where records are missing, contradictory or out of date, the report should say so rather than overstate the certainty of the opinion.
The person should be given a meaningful opportunity to make the decision. This may involve simple language, written summaries, visual aids, additional time, breaks, support with hearing or sight, an interpreter, a familiar setting or a carefully timed appointment. The report should explain what support was tried and whether it helped.
The conversation should explore how the person uses the relevant information, not only whether they can repeat it. Information may be given again or supported with written or visual aids. The aim is to understand the person’s own decision-making, rather than secure agreement with someone else’s preferred choice.
Risk features should be recorded without turning them into shortcuts. Common issues in this area include unclear instructions, missing documents, rushed appointments, poor communication support, conflicts of interest and reports that record conclusions without proper analysis. The assessor should distinguish vulnerability, disagreement, family conflict and safeguarding concerns from evidence that the person is unable to make the decision.
A strong report should include the instruction, the specific decision, the legal framework, the relevant information, evidence reviewed, practicable steps, direct assessment findings, functional analysis, causation and a clear conclusion. It should also explain any limitations, such as missing evidence, refusal to engage, fluctuating presentation or the need for further legal advice.
A good assessment process improves both fairness and evidential value. The person should be supported to decide before any conclusion about incapacity is reached. The safest approach is disciplined and evidence-led: define the decision, tailor the relevant information, support the person, apply the functional test and explain the reasoning clearly.
No. A diagnosis does not establish lack of capacity. For a decision under the Mental Capacity Act, consider the relevant information and practicable support, then assess understanding, retention, use or weighing and communication by any means. Any inability must be caused by an impairment of, or disturbance in the functioning of, the mind or brain. Will-making has its own legal test.
It helps to have the specific decision confirmed in writing, recent medical and care records, any legal documents connected to the decision such as a will file or LPA forms, and practical examples of recent decisions the person has made. Nothing needs to be perfectly organised; the assessor will tell you what matters most for the decision in question.
A formal report may be useful where a legal process, genuine doubt or complexity requires it. It is often unnecessary for everyday undisputed decisions. Tell the assessor about fluctuation and support needs; capacity for one decision does not determine capacity for another, and making a will has a distinct legal test.
The related guides below provide further explanation of the decisions, evidence and legal processes discussed here.
Ask the person what would help and tell the assessor about communication, medication, pain, anxiety or fatigue. Gather the decision documents and relevant records, arrange aids or an interpreter if needed and allow breaks.
A GOOD PLACE TO START
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