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Capacity assessments are often viewed as formal processes designed to determine whether an individual can make a particular decision. Whilst the Mental Capacity Act 2005 provides a clear legal framework for assessing capacity, there remains considerable discussion about how assessments should be conducted in practice.
Capacity assessments are often viewed as formal processes designed to determine whether an individual can make a particular decision. Whilst the Mental Capacity Act 2005 provides a clear legal framework for assessing capacity, there remains considerable discussion about how assessments should be conducted in practice.
For many people, the thought of undergoing a capacity assessment can be intimidating. Individuals may worry that they are being tested, judged, or that someone else will decide what is best for them. Family members can also feel anxious, particularly when important decisions regarding finances, health, care arrangements, or legal matters are involved.
The Mental Capacity Act 2005 was designed to empower individuals and protect their right to make their own decisions wherever possible. However, achieving this in practice requires more than simply applying a legal test. It requires an approach that is person-centred, supportive, and focused on maximising an individual’s ability to participate in the decision-making process.
This is where the principles of Therapeutic Assessment may have an important role to play.
Before exploring therapeutic assessments, it is important to understand the purpose of a mental capacity assessment.
The Mental Capacity Act 2005 establishes a clear legal framework for determining whether an individual can make a specific decision at a specific time. Capacity is both decision-specific and time-specific. A person may have capacity to make one decision but not another, and capacity can fluctuate over time.
The Act is underpinned by five statutory principles:
● Every adult must be assumed to have capacity unless proven otherwise.
● Individuals must be given all practicable support before being treated as unable to make a decision.
● People are entitled to make unwise decisions.
● Decisions made on behalf of someone lacking capacity must be in their best interests.
● Before an act or decision under the Act, consider whether its purpose can be achieved as effectively in a way that is less restrictive of the person’s rights and freedom of action.
These principles are familiar to professionals working within health and social care settings. However, translating them into meaningful practice can sometimes be more challenging than simply understanding them.
The phrase “all practicable steps” is particularly important. It requires assessors to actively support individuals to make decisions before concluding that they lack capacity.
This principle arguably sits at the heart of a therapeutic approach.
Therapeutic Assessment is a collaborative psychological assessment model developed by Dr Stephen Finn and colleagues. The Therapeutic Assessment Institute dates the term to 1993. Its account concerns psychological assessment; applying related values to mental capacity practice is a professional perspective, not evidence that a separately validated MCA assessment method has been established. Source: https://www.therapeuticassessment.com/question2.php
The model was originally developed within psychology, but many of its principles have relevance across a range of assessment settings.
At its core, Therapeutic Assessment is based on collaboration.
Rather than conducting an assessment to a person, the assessor works with them to understand their experiences, concerns, and goals.
The individual becomes an active participant in the assessment process rather than simply the subject of it.
This may sound like a subtle distinction, but it can fundamentally change the experience of assessment.
Historically, some assessments have adopted a highly structured question-and-answer format. Whilst structure is important, an overly rigid approach can create barriers.
Many individuals become anxious when they feel they are being tested. Others may struggle because of communication difficulties, sensory impairments, cognitive challenges, cultural differences, or simply because they are unfamiliar with the assessment process.
When assessments become focused solely on obtaining answers to predetermined questions, there is a risk that the assessor overlooks the person’s strengths, communication style, and preferred ways of understanding information.
This can be particularly problematic in decision-specific mental capacity assessments, where the consequences of a finding of incapacity can be significant.
A person-centred approach requires assessors to look beyond whether someone can immediately answer a question and instead consider what support may help them demonstrate their abilities.
One of the most interesting aspects of Therapeutic Assessment is how closely many of its principles align with the ethos of the Mental Capacity Act.
The MCA places considerable emphasis on involving individuals in decisions affecting their lives.
Similarly, Therapeutic Assessment promotes collaboration throughout the assessment process. Rather than positioning the assessor as the sole expert, both parties work together to develop a shared understanding of the situation.
The MCA begins with the presumption of capacity.
This reflects a fundamental respect for individual autonomy.
Therapeutic Assessment reinforces this by recognising individuals as experts in their own lives and experiences.
Many people undergoing capacity assessments are facing difficult circumstances. They may be living with dementia, acquired brain injuries, learning disabilities, mental health difficulties, or neurological conditions.
A therapeutic approach acknowledges the emotional impact of these experiences and seeks to create an environment where people feel comfortable enough to participate fully.
This can be especially important where the assessment relates to sensitive issues such as capacity for health and welfare decisions, care arrangements, medical treatment, or contact with others.
Capacity assessments are not simply about identifying deficits.
Assessors should be curious about what support may help a person understand, retain, use, weigh, or communicate information.
Sometimes a small adjustment can significantly improve a person’s ability to engage in the assessment process.
Here, a therapeutic approach describes how the person is supported and involved. It is not a separate statutory test, a promise of therapeutic benefit or a replacement for the Mental Capacity Act 2005 in England and Wales.
The legal test remains exactly the same.
An assessor must still determine whether there is an impairment or disturbance in the functioning of the mind or brain and whether that impairment prevents the person from:
● Understanding relevant information.
● Retaining that information.
● Using or weighing that information.
● Communicating their decision.
However, a therapeutic approach influences how the assessment is conducted.
For example, rather than immediately asking direct questions, an assessor may begin by exploring the person’s understanding of the situation through conversation.
Visual aids, written information, diagrams, timelines, photographs, family trees, or practical examples may be used to support understanding.
Information may be presented in different ways and revisited where necessary.
The assessment becomes less about testing knowledge and more about supporting decision-making.
This reflects the MCA’s requirement to take all practicable steps before concluding that someone lacks capacity.
One aspect of capacity assessment that is often overlooked is the impact of the environment.
Individuals are more likely to demonstrate their abilities when they feel comfortable, respected, and understood.
Anxiety can significantly affect communication, memory, concentration, and confidence.
This is particularly relevant for older adults who may have undergone multiple assessments, medical appointments, or investigations.
A therapeutic approach recognises these factors and seeks to reduce unnecessary stress wherever possible.
Something as simple as taking additional time, using familiar language, or building rapport before formal questioning begins can make a considerable difference.
This can also matter in more formal assessment contexts, including COP3 mental capacity assessments, where the report may need to explain not only the conclusion reached, but also what steps were taken to support the person’s participation.
The Mental Capacity Act 2005 provides a strong legal framework, but there continues to be discussion about how assessments can become more person-centred and rights-based.
Therapeutic Assessment offers an interesting perspective because it challenges the idea that assessments should focus solely on identifying difficulties.
Instead, it encourages assessors to explore strengths, provide support, and maximise participation.
Supportive practice can improve the opportunity to participate and the evidence available. The conclusion still needs to satisfy the applicable legal test and explain any limitations.
A report should record what support was offered, how it affected participation and why the evidence supports the conclusion. The description “therapeutic” does not, by itself, establish validity or reliability.
This matters in complex instructions concerning finances, property, LPAs, litigation, care or Court of Protection proceedings. The applicable framework must still be identified: a person’s capacity to make their own will is assessed under the common-law testamentary test, rather than simply applying the MCA functional test.
Capacity assessments are among the most important assessments undertaken within health and social care. The outcomes can affect where a person lives, how their finances are managed, what treatment they receive, and many other aspects of their life.
The Mental Capacity Act 2005 provides the legal framework, but good assessment practice requires more than simply applying legislation.
Therapeutic Assessment reminds us that assessments are ultimately about people. They are not merely exercises in information gathering but opportunities to understand how individuals think, communicate, and make decisions.
By embracing principles such as collaboration, compassion, respect, and curiosity, assessors can create a process that is both legally robust and genuinely person-centred.
In many ways, Therapeutic Assessment reflects the original spirit of the Mental Capacity Act itself: supporting people to make their own decisions wherever possible and ensuring that their voice remains at the centre of the process.
The linked mental capacity assessments page explains the scope of Nellie’s independent services across England and Wales.
Tags:
Mental Capacity Act Code of Practice
Published 26 June 2026
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