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Mental Capacity Assessments are a cornerstone of ethical and lawful decision-making in health and social care. They are designed to empower individuals to make their own decisions wherever possible. However, when working with people who have experienced trauma, particularly survivors of abuse or long-term mental health challenges, the way we communicate during an assessment becomes just as important as the assessment itself. A trauma-informed approach ensures that we do not unintentionally replicate dynamics of powerlessness, coercion, or distress. Instead, we create psychological safety, enabling individuals to engage meaningfully in decisions about their lives. Why Trauma-Informed Language Matters in Mental Capacity Assessments Many individuals undergoing mental capacity assessments may have histories of: ● Domestic or institutional abuse ● Coercion or control ● Psychiatric treatment where autonomy felt limited ● Repeated experiences of not being believed or heard Traditional clinical or directive language can inadvertently trigger these experiences. Even well-intentioned questions may feel interrogative, overwhelming, or disempowering. Trauma-informed language shifts the focus from assessment being done to someone toward a collaborative process done with them. Core Principles of Trauma-Informed MCA Practice Drawing from trauma-informed care frameworks, four key principles should guide communication during a capacity assessment: 1. Safety (Psychological and Emotional) The individual should feel safe, not judged, and not under pressure. ● Avoid abrupt or overly clinical questioning ● Use calm, clear, and respectful language ● Check in regularly: “How are you finding this conversation?” 2. Choice and Control Where possible, restore a sense of autonomy. ● Offer choices about timing, setting, and pace ● Use phrases like:“Would you like to talk about this now, or take a break?” 3. Collaboration Position the person as an active participant, not a passive subject. ● Replace authoritative language with partnership-based phrasing ● Example: Instead of “I need to assess your capacity, ”say “I’d like us to explore this decision together so we can understand what support you might need.” 4. Trustworthiness and Transparency Be open about the purpose of the assessment and how information will be used. ● Explain clearly: “I’m asking these questions to understand how best to support you in making this decision.” Language: Practical Shifts in MCA Conversations Small changes in wording can significantly affect how safe and respected a person feels. Avoid: ● “Why can’t you...?” ● “You need to understand that...” ● “That’s not a rational decision” These can feel blaming, dismissive, or confrontational. Use instead: ● “Can you tell me what’s important to you about this decision?” ● “What are your thoughts about the options?” ● “Would it help if we went through this step by step together?” This type of language invites engagement rather than defensiveness. Supporting Understanding Without Overwhelming A key part of MCA is assessing understanding, retention, and the ability to weigh information. For trauma survivors, cognitive processing may be affected by anxiety, distress, or mistrust. Trauma-informed practice involves: ● Breaking information into manageable parts ● Using plain, non-technical language ● Allowing time for responses ● Repeating or rephrasing without frustration Importantly, difficulty engaging should not be immediately interpreted as lack of capacity, it may reflect emotional overwhelm. Managing Sensitive Topics Some MCA decisions involve deeply personal or potentially triggering topics (e.g., care arrangements, relationships, finances). When discussing sensitive issues: ● Signal the topic gently:“I’d like to talk about something that might feel a bit sensitive. Is that okay?” ● Give permission to pause:“We can stop at any time if this feels too much.” ● Validate emotional responses:“It makes sense this feels difficult to talk about.” This reduces the risk of re-traumatisation and supports continued participation. Power, Authority, and the MCA Process Professionals conducting MCAs hold significant authority. For individuals with trauma histories, this imbalance can mirror past experiences of control. Being mindful of this means: ● Sitting at eye level rather than standing over someone ● Avoiding rushed or pressured interactions ● Explicitly reinforcing the person’s rights under the Mental Capacity Act For example: “You have the right to make decisions that others might see as unwise, my role is just to understand how you’re making this decision.” Conclusion: MCA as an Opportunity for Empowerment When applied thoughtfully, a Mental Capacity Assessment can be more than a legal requirement; it can be an empowering, respectful conversation that supports autonomy. By using trauma-informed language, practitioners can: ● Reduce distress ● Build trust ● Improve engagement ● Support more accurate and ethical assessments Ultimately, the goal is not just to assess capacity, but to do so in a way that honours the individual’s dignity, experiences, and voice.

Gifts are not just a Christmas issue. They come up throughout the year: birthdays, weddings, religious celebrations, anniversaries, charitable donations, inheritance planning, property transfers, financial support for family members, and sentimental gifts made during a person’s lifetime. Sometimes the gift is small and familiar. Sometimes it is substantial: money, jewellery, a vehicle, a share in a property, or even the person’s home. That is when the question becomes more serious: Does the person have the mental capacity to make this specific gift, at this specific time? At Nellie Supports, we provide decision-specific mental capacity assessments for families, solicitors, attorneys, deputies and professionals who need clear, evidence-based answers before important financial or legal decisions are made. What Is Capacity to Make a Gift? Capacity to make a gift means the person can understand the nature and effect of giving something away. This is not about whether other people agree with the gift. It is not about whether the gift seems generous, unusual or unwise. A person is allowed to make a decision that others consider unwise, provided they have capacity to make that decision. The real question is whether the person can understand, retain, use or weigh the relevant information, and communicate their decision. The Mental Capacity Act 2005 framework is decision-specific, which means a person may have capacity for one decision but not another. Nellie Supports explains this wider framework in our Mental Capacity Act 2005 guide. For gifting decisions, the relevant information usually includes: what the gift is the approximate value of the gift who will receive it why the person wants to make the gift whether the gift is affordable how the gift may affect their own future needs how the gift may affect their estate whether other people might reasonably expect to benefit from their estate whether there is any pressure, coercion or undue influence The larger or more unusual the gift, the more careful the assessment needs to be. Why the Size and Nature of the Gift Matters The leading authority on capacity to make lifetime gifts is Re Beaney [1978]. The key principle is that the level of understanding required depends on the size and nature of the gift in the context of the person’s overall assets. The Law Society summarises the position clearly: a small or trivial gift may require a lower degree of understanding, but where the gift disposes of the donor’s only valuable asset or affects how their estate will pass, the person may need a level of understanding similar to that required for making a will. That means there is a major difference between: giving a grandchild £50 for a birthday donating a familiar modest amount to a charity gifting jewellery of sentimental but modest value transferring £20,000 to one child giving away a share of a house transferring the person’s main home making gifts that significantly change inheritance expectations A small customary gift may be straightforward. A large lifetime gift may need a formal capacity assessment and legal advice. Can Someone With Dementia Still Make a Gift? Yes, sometimes. A diagnosis of dementia, acquired brain injury, learning disability, mental illness or cognitive impairment does not automatically mean a person lacks capacity to make a gift. Capacity is not decided by diagnosis alone. It is decided by looking at whether the person can make the particular decision in question. For example, someone may not be able to manage all their finances independently but may still understand a simple, affordable gift to a close family member. Equally, someone may appear socially confident but be unable to understand the consequences of transferring a large sum of money or giving away property. That is why gifting capacity should be assessed in the real-world context of the proposed gift. Where the wider issue is whether the person can manage money, bank accounts, bills or broader financial affairs, a mental capacity assessment to manage finances may also be relevant. Gifts Made by Attorneys or Deputies There is an important distinction between: a person making their own gift, and an attorney or deputy making a gift on that person’s behalf. If the person has capacity to make the gifting decision, they should usually make the decision themselves. If the person lacks capacity, an attorney or deputy may only make gifts within strict limits. Current Office of the Public Guardian guidance says deputies and attorneys have limited powers to make gifts, and that gifts must be reasonable, affordable and in the person’s best interests. The guidance also says the person’s capacity to understand the gifting decision should be considered before a gift is made. For attorneys acting under a property and financial affairs LPA, gifts are generally limited to customary occasions, to people connected with the person or charities they supported or might have supported, and must be reasonable in value considering the size of the person’s estate. Examples of customary occasions can include birthdays, weddings, civil partnerships, Christmas, Eid, Diwali, Hanukkah and Chinese New Year. So yes, Christmas gifting can still sit inside this blog — but as one example of a wider legal issue, not as the whole focus. When a Gift May Need Court of Protection Approval Some gifts go beyond what an attorney or deputy can safely authorise. The Office of the Public Guardian states that any gift or transfer of real property, including land, a house or a share in a property, is almost certainly outside the powers of a deputy or attorney and is likely to require Court of Protection permission. Court approval may also be needed where: the gift is large compared with the person’s estate the gift affects inheritance expectations the gift benefits the attorney, deputy or their family there is a conflict of interest the gift is part of tax planning the gift involves property the person has high care costs or likely future care needs there are safeguarding concerns family members disagree about whether the gift is appropriate Where a Court of Protection application is being considered, a COP3 mental capacity assessment may be needed to provide clear, decision-specific evidence. Where the proposed gift overlaps with estate planning or a statutory will application, our Statutory Will Assessment Package may also be relevant. Capacity to Gift Property Property gifts require particular care. A gift of property may include: transferring a house to a family member gifting a share in a jointly owned property selling a property for less than market value transferring land gifting sale proceeds after a property sale changing ownership arrangements for inheritance or tax reasons These decisions can significantly affect the person’s estate, care funding position, future security and the expectations of beneficiaries. Where the proposed gift involves a home, land or ownership interest, a mental capacity assessment to buy, sell or transfer property may be appropriate. Nellie Supports’ property capacity service expressly covers property decisions including gifting an interest in property. Capacity, Gifts and Lasting Power of Attorney Gifting concerns often arise in LPA cases. Sometimes a person wants to make a Lasting Power of Attorney and also express preferences about gifts, family support or charitable donations. Sometimes an attorney is already acting and wants to know whether they can continue the person’s usual pattern of gifting. It is important to understand that an LPA cannot simply give attorneys unlimited gifting powers. The Office of the Public Guardian guidance explains that preferences and instructions in an LPA must be read in the context of the Mental Capacity Act. A person making an LPA can restrict an attorney’s powers, but cannot expand gifting powers beyond what the law allows. If there is uncertainty about whether someone can make an LPA, Nellie Supports provides mental capacity assessments to grant a Lasting Power of Attorney. Warning Signs That a Gift Needs a Capacity Assessment A formal capacity assessment should be considered where: the person has dementia, brain injury, delirium, mental illness or cognitive impairment the gift is unusually large the gift is out of character the gift favours one person over others without clear explanation the person appears confused about the value of the gift the person does not understand the effect on their own finances the gift may affect care fees or future care planning the proposed recipient has been heavily involved in arranging the gift family members are in dispute there are concerns about undue influence, pressure or coercion the gift may later be challenged after the person’s death Where the matter is complex, disputed or high value, an Enhanced Mental Capacity Assessment may be more appropriate than a standard assessment because it allows for deeper evidential analysis, safeguarding consideration and a more robust report. What Does a Capacity to Make Gifts Assessment Consider? A good gifting capacity assessment should not simply ask, “Do you want to give this gift?” It should explore whether the person understands the decision properly. This may include assessing whether they understand: what they own what they are giving away the approximate value of the gift whether the gift can be reversed who will benefit who may lose out the effect on their future care and living costs the effect on their estate whether they have made similar gifts before whether anyone is pressuring them whether the decision is consistent with their wishes, feelings, values and previous behaviour A mental capacity assessor should also consider what support the person needs to take part in the assessment. This might include simplified explanations, adjusted timing, communication support, visual information, family context or solicitor input where appropriate. What If the Gift Has Already Been Made? Sometimes concerns only arise after the gift has already happened. This might be after a large bank transfer, a property transfer, a change in ownership, or after the person has died and beneficiaries discover that substantial assets were given away during their lifetime. In those cases, the question may become: Did the person have capacity to make the gift at the time it was made? That is a retrospective question. Nellie Supports provides Retrospective Mental Capacity Assessments for disputed past decisions. These reports reconstruct the person’s decision-making ability using contemporaneous evidence such as medical records, care notes, solicitor files, correspondence, bank records and witness evidence. This can be particularly important in probate disputes, financial abuse investigations, contested estates and challenges to lifetime gifts. Capacity to Gift and Testamentary Capacity Large lifetime gifts can overlap with inheritance issues. If a person gives away a major asset during their lifetime, that gift may alter what is left in their estate. It may also affect people who expected to benefit under a will or intestacy. That is why Re Beaney is so important. Where the gift effectively changes the destination of the person’s estate, the level of understanding required may become closer to the understanding needed to make a will. For more detail on the will-making test, Nellie Supports has a guide to Banks v Goodfellow, the leading authority on testamentary capacity. Why Capacity to Make Gifts Matters Gifts can be meaningful. They can preserve relationships, reflect a person’s values, and allow someone to continue patterns of generosity that have mattered to them throughout life. But gifts can also create risk. Without proper capacity evidence, a gift may later be challenged. Families may disagree. Attorneys and deputies may be criticised for acting outside their authority. Solicitors may need clearer evidence before completing a transaction. Vulnerable people may be exposed to financial abuse or undue pressure. A clear assessment can help protect: the person making the gift the intended recipient attorneys and deputies solicitors and professionals involved the person’s estate family relationships future legal proceedings The aim is not to stop people making gifts. The aim is to make sure the person’s decision is properly understood, properly supported and properly evidenced. Need a Capacity Assessment for a Proposed Gift? If you are unsure whether a loved one, client or protected party can make a gift, the safest step is to get advice before the gift is made. Nellie Supports provides independent, decision-specific capacity assessments across England and Wales. Our reports are evidence-based, court-ready where required, and completed by experienced professionals working within clear professional standards and court credentials. You can contact Nellie Supports to discuss whether a gifting capacity assessment, financial capacity assessment, property capacity assessment, retrospective report or enhanced capacity assessment is the right route. For more background reading, visit our Guides and Resource Directory.

Re ACC & Others [2020] EWCOP 9 is now essential reading for property and affairs deputies. It changed the way deputies must think about the limits of their authority, particularly where legal services, contentious steps, conflicts of interest and public funding challenges are involved. For professional deputies, one of the most important practical consequences is the impact on NHS Continuing Healthcare, often shortened to CHC. A deputy may be able to apply for CHC funding on behalf of P. A deputy may also be able to take steps to prepare for, attend and participate in the assessment process. But where a CHC decision is refused and the next step is to challenge that decision, Re ACC draws a line. The Office of the Public Guardian’s current guidance states that general authority to manage P’s funds includes steps up to, but not including, the delivery of a letter of appeal in respect of a decision that P is not eligible for continuing healthcare funding. It also confirms that a deputy may make an application for CHC funding because this is a financial issue. That distinction matters. It means deputies need to think carefully about authority before moving from CHC application and assessment preparation into local resolution, appeal or review activity. Why Re ACC Matters for CHC Funding Cases The difficulty is that CHC does not feel like ordinary litigation. A CHC challenge is not a court claim in the usual sense. It is not issued in the County Court. It does not require a litigation friend in the same way civil litigation would. It is an NHS review process concerned with whether the person has a primary health need and whether the eligibility decision has properly applied the National Framework. The National Framework itself says that individuals do not need legal representation during the CHC eligibility process and describes the process as focused on assessing needs under the Framework, rather than being a legal or adversarial process. That is why Re ACC has caused understandable concern among deputies. On one view, challenging a CHC refusal is simply part of protecting P’s financial position. If P is eligible for CHC, the NHS is responsible for arranging and funding the package of care. That can make a major difference to P’s estate, future care planning and financial security. But the Re ACC position means the deputy must still ask a separate question: Do I have authority to take this next step, or do I need specific authority from the Court of Protection before challenging the decision? What Deputies Can Usually Do Without Further Court Authority In most cases, a property and affairs deputy can take sensible preparatory steps to ensure that CHC is properly considered. This may include: identifying that P may be eligible for CHC requesting that CHC eligibility is considered gathering care records, health evidence and relevant financial information ensuring that P is represented at the assessment stage instructing appropriate professional support for the assessment, where this is within the deputy’s authority and proportionate attending or arranging representation at the Decision Support Tool meeting reviewing the outcome of the assessment and taking advice on whether the decision appears sound The current CHC pathway usually begins with a Checklist and, where the threshold is met, proceeds to a multidisciplinary assessment using the Decision Support Tool. Nellie Supports also explains the full route through the NHS Continuing Healthcare process, including Checklist, DST, decision letter, local resolution, Independent Review Panel and Ombudsman stages. That early stage is where deputies can add real value. A properly prepared DST meeting can reduce the risk of an inaccurate decision. It can ensure that key evidence is available, that care needs are described clearly, and that the domains are not considered in isolation from the nature, intensity, complexity and unpredictability of P’s needs. Where the Line Is Drawn The risk point comes after a negative eligibility decision. If the ICB refuses CHC funding and P or their representative wishes to challenge that decision, the first formal stage is usually local resolution. The National Framework says that where an individual or their representative asks the ICB to review the eligibility decision, this should be dealt with through the local resolution procedure. All ICBs must have a CHC local resolution process that is fair, transparent and includes timescales. For deputies, the issue is not whether the CHC process allows a representative. It does. The issue is whether the property and affairs deputy has authority to take the step that begins the challenge. Under Re ACC and the OPG guidance, deputies should not assume that general authority permits them to launch the appeal or review process. Specific Court of Protection authority may be required before sending the appeal letter or taking further contentious steps. Where a deputy is considering challenge after a refusal, a fixed-fee CHC appeal viability review can help clarify whether the decision appears challengeable before further cost is incurred. Why This Creates Practical Problems for Deputies This can be difficult in real cases. CHC decisions often arrive at a time when care costs are already significant. P may be paying privately for a care home or complex package of support. The deputy may believe that the decision is wrong, that key evidence has been overlooked, or that the DST did not properly reflect the severity of P’s needs. But applying to the Court of Protection for authority takes time and adds cost. That creates tension where there are review deadlines, ongoing care fees and a potential loss to P’s estate if the funding decision is not challenged. For professional deputies, the practical message is clear: Do as much high-quality work as possible before the decision is made. The better the assessment preparation, the lower the risk of needing to challenge a poor decision later. The Best Strategy: Get the DST Right First Time A CHC appeal can sometimes be avoided by making sure the assessment stage is handled properly. That means deputies should consider arranging experienced DST attendance and representation before the meeting, not only after funding has been refused. At the DST stage, a knowledgeable representative can help ensure that: the meeting is properly prepared relevant records are available the correct care domains are explored the evidence reflects P’s actual presentation, not just what is written in a care plan needs are considered in combination, not artificially separated the primary health need test is properly addressed disagreements are recorded clearly procedural concerns are documented at the time This does not guarantee eligibility. Nothing can. But it does mean that the case has been properly presented before the ICB makes its decision. If CHC is awarded, the cost and delay of a challenge may be avoided. If CHC is refused, the deputy is in a stronger position to decide whether an application to the Court of Protection for authority to challenge is justified. When a CHC Decision Should Be Reviewed A negative CHC decision should not be challenged simply because the outcome is disappointing. A review may be worth considering where there are clear concerns such as: the DST domains do not reflect the evidence care records were not properly considered the MDT did not consider the interaction between needs the primary health need analysis is weak or missing the decision focuses too heavily on diagnosis rather than needs family or professional evidence was ignored the written rationale does not explain how the conclusion was reached the process did not follow the National Framework there are clear gaps between the evidence and the eligibility decision This is where an independent professional review can be useful. Before a deputy seeks Court of Protection authority to challenge a CHC refusal, they should be able to explain why the challenge is in P’s best interests, what the issue is, what the potential financial benefit may be, and why the proposed work is proportionate. Where the matter has already reached the first formal challenge stage, deputies may need support with local resolution CHC appeal preparation, including written grounds, evidence structure and representation. Court of Protection Authority and Proportionality Re ACC also reminds deputies that they must consider the limits of their authority and act carefully where proposed work falls outside the deputyship order. For professional deputies, this means the decision to pursue a CHC challenge should be properly documented. A deputy should usually consider: the wording of the deputyship order the value of the potential CHC funding the strength of the challenge the cost of obtaining advice or representation whether urgent action is needed whether another person is better placed to act whether Court of Protection authority is required whether any conflict of interest arises how the decision will be explained in the deputyship annual report This sits alongside the wider Mental Capacity Act framework. Nellie Supports has a detailed guide to the Mental Capacity Act 2005, including decision-specific capacity, best interests and the legal structure that underpins Court of Protection work. Where a deputyship application or Court of Protection evidence is also needed, deputies and solicitors may also need a COP3 mental capacity assessment prepared for the specific decision before the court. What Deputies Should Do Going Forward The safest approach is to build CHC consideration into the deputyship file early. Do not wait until care costs have been paid for months or years before asking whether P might qualify for NHS Continuing Healthcare. Do not assume that a negative decision is correct. But equally, do not assume that a property and affairs deputy can move straight into an appeal without checking authority. A robust deputyship approach should include: early screening for possible CHC eligibility prompt request for assessment where appropriate proper preparation before the DST meeting professional representation where the facts justify it careful review of any negative decision clear advice on whether there are grounds to challenge documented best interests reasoning Court of Protection authority where required before appeal steps are taken This is not about creating unnecessary process. It is about protecting P, protecting the deputy and making sure public funding issues are handled lawfully, proportionately and at the right stage. How Nellie Supports Can Help Nellie Supports provides specialist CHC support for deputies, solicitors, attorneys and families. Our expert team, is experienced in supporting individuals through the CHC assessment process, including DST preparation, representation and review of CHC decisions. We can assist with: CHC Assessment Preparation We help deputies identify whether CHC should be considered, what evidence is needed, and how P’s needs should be presented before the assessment takes place. Where the case is at an early stage, our CHC Checklist request and advocacy letter service can help ensure the request is properly framed from the outset. DST Meeting Representation We can represent P’s interests at the full CHC assessment, helping to ensure the meeting is thorough, properly evidenced and focused on the correct eligibility test. Review of Negative CHC Decisions Where funding has been refused, we can review the decision and advise whether the outcome appears properly reasoned, evidence-based and compliant with the National Framework. Evidence for Court of Protection Applications Where a challenge may be appropriate, we can provide supporting analysis to assist deputies and their legal advisers when considering whether to seek Court of Protection authority to proceed. Retrospective CHC Funding Support Where the issue relates to past care fees, we can also advise on retrospective CHC funding appeals, including whether there may be grounds to recover care fees paid during a period when CHC should have been considered. Speak to Nellie Supports If you are a deputy dealing with a possible CHC case, the best time to act is before the process goes wrong. Early preparation can reduce the risk of an inaccurate decision, avoid unnecessary appeal costs and help ensure P’s needs are properly evidenced from the outset. Nellie Supports is an independent practice with published professional standards and credentials, providing structured support across CHC, mental capacity and Court of Protection-related work. Book a free, no-obligation call with Nellie Supports to discuss CHC assessment support, DST representation or review of a refused funding decision.

If you have ever opened an Education, Health and Care Plan and found phrases like “support as required,” “access to support,” “opportunities for,” or “where appropriate,” you already know the problem. Vague wording sounds helpful. In real life, it can leave your child without clear provision, leave school unsure what must happen, and leave you stuck chasing answers that should have been written into the plan from the start. That is why we built Little Nellies. Little Nellies is the parent-facing SEND support brand from Nellie Supports. We help families cut through EHCP jargon, challenge weak wording, organise evidence, and move through the SEND process with more confidence — from the first refusal letter through to mediation and SEND Tribunal preparation. No waffle. No legal fog. No “we’ll see how it goes.” Your child’s support should be clear, specific, and written down properly. Who Little Nellies Is For Little Nellies is for parents and carers who feel like they have been handed a process instead of proper support. You might be: staring at a refusal to assess letter and wondering what to do next reading a draft EHCP that describes your child beautifully but does not secure the support they need dealing with vague provision that says who might help, but not what they will do, how often, or for how long preparing for mediation and unsure what evidence matters facing a SEND Tribunal appeal and feeling overwhelmed by paperwork, deadlines, and council language We help you understand the stage you are at, what the documents actually say, what is missing, and what needs to happen next. What We Do Little Nellies gives parents practical, plain-English EHCP support at the points where families often feel most stuck. Refusal to Assess Support If the local authority has refused to carry out an EHC needs assessment, we help you understand the refusal, identify evidence gaps, and prepare a stronger challenge. We focus on the key question: what evidence shows that your child may need support through an EHCP? Draft EHCP Reviews A draft EHCP should not be full of soft promises. It should clearly set out your child’s needs, outcomes, and provision. We review draft plans line by line and look for: vague language missing needs weak or unsupported outcomes provision that is not specific, quantified, or enforceable gaps between professional evidence and what the plan actually includes wording that leaves too much room for delay or disagreement If the plan says “support as required,” we ask: support from whom, doing what, how often, for how long, and where is that written? Evidence Packs EHCP decisions often turn on evidence. Parents may have reports, school emails, appointment letters, behaviour logs, professional recommendations, and their own lived experience — but no clear structure. We help organise evidence into a focused pack that shows: what your child needs what has already been tried what is not working what professionals recommend where the EHCP or local authority decision falls short Mediation Preparation Mediation can feel intimidating, especially when you are expected to discuss your child’s needs with professionals who use formal language every day. We help you prepare your key points, questions, evidence, and priorities before the meeting so you know what you are asking for and why. SEND Tribunal Support When an appeal reaches SEND Tribunal, the paperwork can become heavy very quickly. Our tribunal support can include help with appeal preparation, evidence organisation, working documents, bundle checks, written arguments, and advocacy through the package you choose. The aim is simple: help you present your child’s case clearly, calmly, and with evidence behind every point. Our Services Draft EHCP Review A professional review of your child’s draft EHCP, highlighting vague wording, missing detail, weak provision, and areas that need strengthening before the plan is finalised. Evidence Pack Build Support to organise your documents into a clear, structured evidence pack that connects your child’s needs to the provision being requested. Tribunal Preparation and Advocacy Practical support with tribunal paperwork, working documents, evidence, bundle preparation, and representation where this is included in your chosen package. Why the Punk Edge? Because SEND parents do not need another beige leaflet. You need clear language, honest feedback, and someone willing to say: This wording is too vague.This provision is not clear enough.This plan does not yet say what your child needs.Here is how we strengthen it. The Little Nellies style is bold for a reason. The black-and-hot-pink look, the direct language, and the no-fluff tone all point to the same belief: Parents should not need a law degree to understand their child’s EHCP. Why Families Trust Little Nellies Families come to Little Nellies because we combine professional SEND knowledge with plain-English support. We are: qualified and experienced — backed by the professional expertise of Nellie Supports specific — we do not hide behind vague language practical — we give parents tools they can actually use clear on costs — fixed-fee options, no nasty surprises evidence-led — we focus on what the documents show, what is missing, and what needs strengthening parent-first — we know this is not just paperwork; it is your child’s support, education, and future We do not promise magic. We do not guarantee outcomes. We do promise clear, careful, robust work that helps you understand the process and challenge weak EHCP decisions with more confidence. What “Good” EHCP Wording Looks Like A strong EHCP should not leave everyone guessing. Instead of: “Support will be provided as required.” A stronger plan should explain: who will provide the support what type of support will be delivered how often it will happen how long each session or intervention will last where the support will take place how progress will be reviewed what specialist input is needed Specific wording matters because vague wording can become vague provision. And vague provision is not good enough for your child. Ready to Get Your Child’s EHCP Properly Checked? Bring us the letter, draft plan, tribunal notice, or bundle that is keeping you awake. We will help you understand what stage you are at, what looks weak, and what support would make the biggest difference. Book your free 15-minute call and speak to someone who gets it.

Before a mental capacity assessment takes place, the person being assessed should understand, as far as possible, what the assessment is about and why it is being carried out. That may sound straightforward, but in practice it is one of the most important parts of a lawful, fair and reliable assessment. A capacity assessment is not simply a conversation in which an assessor gathers answers. It is a structured process that may affect legal, financial, welfare or court-related decisions. The person should therefore be given a genuine opportunity to understand the purpose of that process before conclusions are drawn. Explaining the purpose of the assessment is not just a matter of professional courtesy. It supports transparency, respects the person’s autonomy, and helps ensure that any conclusion about capacity is based on the person’s actual decision-making ability, rather than confusion about why they are being asked questions. Why the purpose of the assessment matters Mental capacity is decision-specific. This means the question is not whether a person has capacity in general, but whether they can make a particular decision at the relevant time. For that reason, the person being assessed needs to know what decision is being considered. For example, an assessment might relate to managing finances, making a will, granting a lasting power of attorney, deciding where to live, consenting to care arrangements, or taking part in legal proceedings. Those are very different decisions. Each one involves different information, different consequences and different risks. If the person does not understand what decision is being assessed, their answers may not reliably show whether they can understand, retain, use or weigh the relevant information. In simple terms, the person should not be left guessing why the assessor is there. The Calderdale point: transparency is part of reliability The importance of explaining the purpose of an assessment has been highlighted in case law, including Calderdale Metropolitan Borough Council v LS & Anor. The practical point is clear: if a person is not told what an assessment is actually about, the reliability of the assessment may be called into question. A person’s responses may be affected by anxiety, confusion, mistrust or misunderstanding. They may think the assessor is there for a different reason. They may answer cautiously, defensively or inconsistently because they do not understand the context. That does not mean every explanation must be lengthy or technical. In many cases, a short and accessible explanation will be more appropriate. What matters is that the assessor makes a proper attempt to explain the purpose in a way the person can understand. For example, instead of saying: “I am here to conduct a Mental Capacity Act assessment in relation to your property and affairs.” An assessor might say: “I’m here to talk with you about whether you feel able to make decisions about your money, bills and property at the moment. I’ll ask some questions to understand what you know, what choices you have, and what you think about those choices.” The second version is more likely to be meaningful to the person. It explains the purpose without relying on legal language. Explaining the assessment is part of supporting decision-making Under the Mental Capacity Act 2005, a person should not be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success. Explaining the purpose of the assessment sits naturally within that principle. It helps the person understand what is happening, why the decision matters, and what information they are being asked to consider. This is particularly important where the person has dementia, acquired brain injury, a learning disability, mental illness, delirium, communication difficulties or another condition that may affect how they process information. A person may struggle with a question not because they lack capacity, but because the question has been put too quickly, too abstractly or without enough context. A good assessment should reduce those barriers wherever possible. That may involve: using plain language avoiding legal or professional jargon breaking information into smaller parts checking whether the person understands why the conversation is taking place allowing extra time using visual aids or written prompts where helpful choosing a familiar or calm environment involving communication support where appropriate The aim is not to coach the person into a particular answer. It is to give them a fair opportunity to engage with the decision. Communication should be adapted to the person Capacity assessments often involve complex information. The assessor may need to explore options, consequences, risks, benefits, legal documents, care arrangements or financial circumstances. However, the information should be presented in a way the person can realistically understand. An assessment that relies on technical wording may test the person’s ability to understand jargon, rather than their ability to make the actual decision. Good communication means adapting the explanation to the person, not expecting the person to adapt to the assessor. For example, where someone is anxious, the assessor may need to begin with reassurance and a clear explanation of their role. Where someone has memory difficulties, the assessor may need to repeat key points and check understanding more than once. Where someone has communication difficulties, the assessor may need to use alternative methods, such as written information, pictures, communication aids, interpreters or support from someone who understands the person’s communication style. The assessment should focus on whether the person can make the decision with appropriate support, not whether they can manage unsupported in an artificial or unfamiliar setting. The environment can affect understanding The setting of the assessment can make a significant difference. A noisy, unfamiliar or pressured environment may increase confusion and reduce the person’s ability to engage. A quieter and more familiar setting may help the person concentrate and respond more clearly. For some people, the timing of the assessment is also important. A person may be more alert in the morning, more fatigued later in the day, or affected by medication, pain, distress or recent events. These practical details matter because capacity is assessed at the time the decision needs to be made. If the person’s presentation fluctuates, the assessor should consider whether the timing and setting of the assessment give a fair picture of their decision-making ability. This does not mean assessments must always take place in perfect conditions. That is rarely possible. But the assessor should think carefully about barriers to engagement and record what steps were taken to reduce them. Checking understanding without turning the assessment into an exam Explaining the purpose of the assessment is only the first step. The assessor also needs to consider whether the person has understood that explanation. This does not have to be done formally or harshly. It can be approached naturally within the conversation. For example, the assessor might ask: “Can you tell me, in your own words, what you understand we are talking about today?” Or: “What do you think the main decision is that we are discussing?” This helps the assessor understand whether the person has grasped the purpose of the conversation. It also gives the person an opportunity to correct any misunderstanding. The tone is important. The assessment should not feel like an interrogation. A person-centred approach, using empathy, patience and active listening, will usually produce better evidence than a rigid checklist. What should be recorded in the assessment report? A strong capacity report should not simply state that the purpose was explained. It should briefly record how it was explained and how the person responded. For example, the report might include: “I explained to Mrs A that the purpose of the assessment was to consider whether she could make her own decision about managing her property and financial affairs. I explained this in plain language, referring to her bank account, household bills, savings and property. Mrs A was able to tell me that she understood I was there to discuss whether she could manage these decisions herself or whether someone else may need legal authority to assist.” Or, where the person did not understand: “I explained the purpose of the assessment in simple terms and repeated the explanation using examples relating to Mr B’s care arrangements. Mr B was unable to describe why the assessment was taking place and repeatedly stated that I was there to arrange a hospital appointment. Further attempts were made to reframe the explanation, but he remained unable to understand the purpose of the discussion.” This kind of recording is useful because it shows the assessor has considered transparency, communication and support. It also helps demonstrate that the assessment was not a tick-box exercise. Can AI help explain capacity assessments? Artificial intelligence may have a limited supporting role in this area, particularly where professionals need to convert complex information into simpler language. For example, AI may help draft a plain-language explanation of a decision, summarise options in accessible wording, or produce a short written prompt that can be adapted for the person being assessed. However, AI should not replace professional judgement. It should not decide whether someone has capacity, interpret the person’s answers in isolation, or be used without careful review. Any wording generated by AI must be checked by the assessor to ensure it is accurate, appropriate and tailored to the person’s circumstances. Used carefully, AI may assist communication. Used carelessly, it may introduce errors, oversimplify important information or create a false impression that the person has been properly supported. The key point remains the same: the assessor is responsible for ensuring the person receives the relevant information in a way that is accessible and meaningful. Why this matters for families, solicitors and professionals Families, solicitors and professionals often focus on the final outcome of a capacity assessment: does the person have capacity or not? But the process matters just as much as the conclusion. If the purpose of the assessment has not been explained, or if the explanation has not been adapted to the person’s needs, the assessment may be vulnerable to challenge. It may be unclear whether the person truly could not make the decision, or whether they were not properly supported to understand what was being asked of them. A robust assessment should show: what decision was being assessed how the purpose of the assessment was explained what relevant information was provided what steps were taken to support understanding how the person responded how the assessor reached their conclusion This is especially important in court-related assessments, disputed family situations, property and financial matters, and cases where the person’s presentation is borderline or fluctuating. Conclusion Explaining the purpose of a mental capacity assessment is a fundamental part of good practice. It protects the person’s right to participate, supports the Mental Capacity Act principle of taking practicable steps, and improves the reliability of the assessment itself. It also helps ensure that the assessor is testing the person’s decision-making ability, not their ability to work out why unfamiliar questions are being asked. A clear explanation does not need to be complicated. It should be honest, accessible and tailored to the person. The assessor should then check understanding, adapt communication where needed, and record what was done. A capacity assessment is strongest when the person has been given a genuine opportunity to understand the process and take part in the assessment making it both robust and defensible. Need a decision-specific mental capacity assessment? Nellie Supports provides independent, decision-specific mental capacity assessments for families, solicitors and professionals across England and Wales.

During a recent training session our team engaged in an interesting discussion surrounding how we as professionals balance this very tension within our practice. As Mental Capacity Assessors , we are tasked with producing assessments that are robust, evidence-based , and able to withstand scrutiny whilst at the same time, being bound by the principles of the Mental Capacity Act (2005) to remain person-centred, supportive, and least restrictive. In practice, this creates a familiar tension: How do we ensure an assessment is sufficiently thorough and defensible, whilst also recognising when continuing to question an individual may cause distress or overwhelm? This question is a well recognised ethical and theoretical challenge within social work and capacity law. Research into practitioners’ experiences consistently highlights this issue. Social workers often describe capacity assessments as navigating a “grey area” between thoroughness and emotional impact. While there is understandable pressure to produce assessments that will stand up in court , there is also a strong awareness that: ● repeated or persistent questioning can cause distress or fatigue, ● emotional overwhelm may undermine the reliability of responses, ● and the assessment process itself can risk becoming intrusive or coercive. Capacity assessments involve professional judgement , interpretation, and relational engagement particularly when applying the “ use or weigh ” element of the functional test. The Mental Capacity Act itself embeds this tension. On one hand, it requires clear evidence of the functional test of capacity alongside transparent reasoning that can be scrutinised whilst at the same time demanding a presumption of capacity, active steps to support decision-making and a commitment to the least restrictive option. NICE guidance reinforces that assessments must be “structured, person-centred, empowering and proportionate.” Importantly, the law does not require us to pursue questioning at all costs. Instead, it expects us to act reasonably and proportionately, while maximising the person’s ability to engage. So this begs the question: what do we do when continuing an assessment risks overwhelming or distressing the person but stopping might feel like we haven’t done enough? It is important to recognise here that this isn’t just personal uncertainty. It’s something that has been widely recognised and researched in law and social work theory. In other words, if you ever feel like this it is important to know you are not alone. So what should we do when someone becomes overwhelmed? One of the most helpful ideas from recent research is the social model of mental capacity which suggests that capacity is not just something inside a person but that it is also hugely affected by their environment, relationships and emotional state. For instance, a calm, supported person may be able to weigh information but the same person, should they become overwhelmed, may no longer be able to weigh that same information. From this perspective, if someone becomes distressed during an assessment, it is not separate from capacity but in fact part of the evidence about how they are functioning in that moment. Research also shows that good capacity assessments rely heavily on things such as trust, communication and understanding, linking closely to relational practice. These approaches tell us that how we carry out an assessment is just as important as what we ask. For instance, if a person does become overwhelmed they may agree to end the conversation, disengage, or their answers may no longer reflect their true thinking. This would mean that continuing to question them could actually lead to the assessment being less reliable, not more. The Mental Capacity Act requires us to take “all practicable steps” to support someone to make their own decision. Support might include: slowing the pace, using simpler language, taking breaks or involving someone the person trusts. Being able to document the support provided serves to strengthen your assessment by providing evidence that you have followed the law. If someone becomes distressed, a strong and defensible response is to recognise that their ability to engage is affected, consider whether continuing would reduce the reliability of responses, adjust your approach (e.g. slow down, pause, simplify) and clearly document what happened and why. This shows you are applying both the functional test of capacity and the principles of the MCA. My final thoughts: Ultimately, the idea that we must choose between being person-centred and being legally robust is misleading. The evidence suggests something more nuanced in that capacity assessments are most defensible when it is relationally informed, ethically grounded, and context-aware. In practice this means, recognising distress as part of the assessment, supporting the person to engage , knowing when to pause/ take breaks and clearly evidencing your reasoning. Ultimately, person-centred practice is not a barrier to defensibility, it is part of what makes an assessment valid, reliable, and lawful. If you need a mental capacity assessment that is both person-centred and able to withstand legal scrutiny, our team provides mental capacity assessment service s  designed for families, solicitors and professionals. We specialise in expert capacity assessments for court or legal use , ensuring clear reasoning, structured evidence, and reports that are robust under challenge. Abbie Cripwell Social Worker and Expert mental capacity assessor

by Kerry Slater MSc BSc Life expectancy evidence is rarely simple. In legal, Court of Protection, clinical negligence, statutory will and care-planning matters, a short prognosis can have significant consequences. It may affect settlement calculations, future care planning, inheritance decisions, Court of Protection applications, NHS Continuing Healthcare considerations, and the way families and professionals approach urgent decisions. That is why a GP’s view, while important, may not always be the end of the analysis. At Nellie Supports, our Life Expectancy Reports provide structured, evidence-based projections that consider the full medical, functional, social and statistical picture. These reports are often required where life expectancy is a live issue in litigation, expert witness reporting, Court of Protection work or complex family decision-making. This anonymised case example shows why a second opinion can be so important. The Background: A Six-Month Prognosis The individual in this case was elderly and had several serious health conditions, including advanced mixed dementia, cardiovascular disease, recurrent infections, osteoporosis, falls risk and suspected liver dysfunction. Their GP had estimated life expectancy at approximately six months. That opinion was clinically significant and could not be ignored. However, the instructing party needed a fuller independent view: one that considered not only the medical diagnoses, but also the person’s functional presentation, care arrangements, comorbidities, likely disease trajectory, and the extent to which pending investigations could materially change the prognosis. A life expectancy report is not about replacing the treating clinician. It is about testing the evidence, explaining the reasoning, and setting out a defensible opinion that can be understood by solicitors, deputies, families, insurers or the court. Medical Factors Considered in the Life Expectancy Assessment The assessment required careful review of several overlapping conditions. None could be considered in isolation. Advanced Dementia The individual had a confirmed diagnosis of mixed dementia, with cognitive and functional decline consistent with advanced-stage disease. In a life expectancy context, dementia is not assessed only by diagnosis. The relevant questions include: the person’s level of communication ability to recognise people and surroundings mobility and transfers continence swallowing and nutrition frequency of infections level of dependency whether deterioration is gradual, stepwise or rapid Advanced dementia can be life-limiting, but prognosis is often uncertain. Some people deteriorate quickly; others remain clinically stable for longer than expected, particularly where care is consistent and complications are managed promptly. Cardiovascular Disease The individual also had chronic ischaemic heart disease and atrial fibrillation. Cardiovascular disease can increase mortality risk, particularly where there is frailty, reduced mobility, infection risk or limited physiological reserve. In this case, it was not enough to note the diagnosis. The report needed to consider whether the cardiovascular condition was stable, deteriorating, poorly controlled, or interacting with other risks. Suspected Liver Dysfunction Blood abnormalities suggested possible liver dysfunction, with further investigation pending. This was one of the most important uncertainties in the case. If further investigations confirmed malignancy or significant progressive liver disease, the prognosis could shorten substantially. If the abnormalities were explained by a less aggressive cause, the outlook could be different. That uncertainty needed to be reflected in the opinion rather than hidden behind a single fixed estimate. Recurrent Infections and Frailty The individual had a history of recurrent urinary tract infections and other systemic infections. In an older person with advanced dementia, recurrent infection can be a marker of increasing frailty and reduced resilience. The report considered: infection frequency whether infections required hospital admission response to antibiotics recovery after each episode nutritional intake after illness whether there was evidence of stepwise decline after infections This matters because repeated infection can accelerate functional decline, especially where the person does not return to their previous baseline. Osteoporosis, Falls and Reduced Mobility The individual had osteoporosis, previous fractures and significant mobility limitations. Falls risk and immobility can affect life expectancy indirectly by increasing the risk of fractures, hospital admission, deconditioning, pressure damage, infection and loss of independence. In this case, the person required full-time care, which reduced some immediate environmental risks but did not remove the underlying medical vulnerability. Where long-term care, support needs and future costs also need to be quantified, life expectancy evidence may sit alongside a Future Care and Costings Report. How the Life Expectancy Assessment Was Completed A robust life expectancy opinion should not rely on one diagnosis or one conversation. It should bring together the available evidence and explain how each factor affects the final opinion. In this case, the assessment involved: Medical Record Review The person’s medical history, diagnoses, treatment records, medication profile, blood results and recent clinical presentation were reviewed to understand both long-term conditions and current risk. Functional and Care Context The report considered the person’s daily functioning, dependency, mobility, care setting, nutritional risks, infection history and support arrangements. This is important because life expectancy is not shaped by medical diagnoses alone. The stability and responsiveness of the care environment can affect immediate risk, particularly in cases involving dementia, frailty and recurrent infection. Where wider care arrangements need professional review, Nellie Supports also provides independent social care assessment and care planning. Statistical and Medical Literature Review Population averages can be misleading when the individual has complex comorbidities. The report therefore considered the person’s age, diagnosis profile, functional status and known risk factors alongside relevant statistical and clinical literature. The aim was not to produce false precision. It was to identify a reasonable evidence-based range and explain why that range differed from, or aligned with, the GP’s shorter estimate. Uncertainty and Scenario Planning The pending liver investigations meant the report needed to account for more than one possible trajectory. A strong prognosis report should explain uncertainty openly. In this case, the likely range depended heavily on whether suspected liver dysfunction represented a serious progressive condition, such as malignancy, or a less immediately life-limiting issue. Key Findings from the Expert Assessment The GP’s estimate of six months was not unreasonable given the severity of the person’s health conditions. However, it was not the only defensible view. The independent assessment concluded that life expectancy was more appropriately expressed as a range rather than a fixed date. In this case, the most defensible opinion was that life expectancy was likely to fall within approximately six to eighteen months, depending on: the outcome of liver investigations whether recurrent infections continued or increased nutritional status and hydration further falls or fractures any hospital admissions and recovery pattern whether the current care environment remained stable whether there was evidence of rapid stepwise deterioration This type of range is often more useful than a single estimate because it reflects the reality of complex ageing, dementia and comorbidity. Why the Six-Month Figure Still Mattered Although the expert opinion widened the possible range, the GP’s six-month prognosis remained clinically important. A six-month estimate may indicate that professionals should consider: urgent future care planning whether the person may be approaching end of life whether palliative care input is appropriate whether NHS Continuing Healthcare or Fast Track funding should be explored whether legal decisions need to be progressed promptly whether the person’s wishes, feelings and best interests have been properly documented Where care funding may be relevant, families and professionals may also need advice on NHS Continuing Healthcare support, particularly where needs are complex, intense, unpredictable or rapidly deteriorating. The key point is this: a short prognosis should trigger careful planning, but it should still be tested against the wider evidence. Why Expert Life Expectancy Reports Matter Life expectancy reports are often required where the projected lifespan affects legal, financial or welfare decisions. They may be relevant in: clinical negligence claims personal injury litigation Court of Protection proceedings statutory will applications deputyship matters care-cost disputes insurance or dependency claims settlement negotiations future care planning In some matters, life expectancy evidence may be only one part of a wider evidential package. For example, Nellie Supports’ Statutory Will Assessment Package can bring together life expectancy opinion, care evidence, costs evidence, testamentary capacity assessment and COP3 completion where required. Where capacity is also in question, our Mental Capacity Assessments provide decision-specific, court-ready evidence for solicitors, deputies, families and professionals. What Makes a Strong Life Expectancy Report? A strong report should be clear, evidence-based and transparent about its limitations. It should explain: what records were reviewed what diagnoses were relevant which conditions materially affected prognosis whether the person’s condition was stable, deteriorating or uncertain how functional presentation affected risk how care arrangements reduced or increased risk whether further investigations could change the opinion why the final range was selected what assumptions the opinion depended on The best reports do not pretend to know the unknowable. They identify the most likely range, explain the reasoning and set out the factors that could move the prognosis up or down. That is what makes the report useful for legal and professional decision-making. The Role of Second Opinions A second opinion is not about criticising the first professional. It is about asking whether the original prognosis: considered all relevant medical conditions accounted for functional decline and frailty reflected pending investigations explained uncertainty clearly distinguished between best-case, likely and worst-case scenarios provided enough reasoning for legal or financial reliance In this case, the second opinion did not dismiss the GP’s six-month estimate. Instead, it placed that estimate within a wider evidential framework and concluded that a range of six to eighteen months was more appropriate, subject to the outcome of further investigations. That distinction matters. For families, deputies and legal teams, it can change how urgent a matter is, how evidence is presented, how care costs are calculated, and how future decisions are planned. How Nellie Supports Can Help Nellie Supports prepares Life Expectancy Reports for solicitors, deputies, insurers, case managers and families who need clear, evidence-based opinion in complex cases. Our reports can support: personal injury and clinical negligence claims Court of Protection applications statutory will matters future care and costings evidence complex care planning settlement discussions cases where prognosis is disputed or uncertain Our wider Court Reports and Expert Assessments service also includes care needs reports, future care and costings, capacity evidence and other expert social work reporting. Nellie Supports operates within clear Professional Standards and Court Credentials, with structured governance, quality assurance and experience across mental capacity, care funding, CHC, expert reporting and Court of Protection-related work. We support clients across England and Wales, with further information available on our National Coverage page. Need a Life Expectancy Report? If you are dealing with a case where life expectancy affects legal, financial, care or Court of Protection decisions, a clear expert report can help bring structure to the uncertainty. You can contact Nellie Supports to discuss whether a Life Expectancy Report is appropriate, what records are needed, and how the report can support the decision being made. For wider reading, you can also visit our Guides and Resource Directory, which brings together guidance across mental capacity, Court of Protection, social care, care funding, EHCP and expert reports.

Mental Capacity assessments are often seen as a tool, a way of identifying if someone does or does not have the prerequisite cognitive ability to make a specific decision, and that is what the Mental Capacity Act (2005) tells us it is for, which it would its a piece of legislation, which is a tool telling us how to apply another tool. But the test isn't a tool; no test is, not when it's applied correctly by a skilled practitioner. Shift in Approach The changes brought about by the Mental Capacity Amendment Bill (2019) saw a fundamental shift from a medical model or pathological approach to the test in the MCA to a more person-centred approach, with the focus being put on the functional test over the diagnostic test. Pre-COVID, the rhetoric around mental capacity assessments was that they were a "clinical assessment" and needed to be as they were evidence-based and forensic in nature. Assessment vs. Report Language is important here; there is a difference between an assessment and a report. Before delving further, it's crucial to distinguish between an assessment and a report. Assessment is defined as the act of "the action of assessing someone or something." assessing is essentially the act of sitting in someone's house and evaluating their ability. A report is defined as "giving a spoken or written account of something that one has observed, heard, done, or investigated". A Mental Capacity Assessment Report must be forensic, evidence-based and almost academic in its tone; this needs to be clinical. The report is a piece of piece of evidence that is being submitted to the courts. The Therapeutic Approach So while a report needs to be clinical, evidence-based, and forensic, the assessment should be humanistic in nature, focusing on a strength-based approach, which itself should lead to an empowering of P. The alternative of a clinical assessment can, for the most part, place "p" under pressure, be stressful and result in outcomes that are skewed by the environment and (and often overlooked) result in poor outcomes for P. Best Practice Approach But if we apply a therapeutic nature to an assessment, then the test becomes a tool that can empower, strengthen and support P. In social work, there is an approach referred to as "the best practice approach." Essentially, this approach explains that the process is more important than the outcome; after all, the outcome will be what it is, how we as practitioners manage the assessment process, though it can have profound impacts on P. Tailoring the Therapeutic Approach This best practice approach or therapeutic approach to assessing mental capacity needs to be different for every individual and calls on the practitioner to have a good grounding knowledge in counselling theories and sociology theories, such as systems theory. This underpinning knowledge and skills help to identify the right way of engaging with a client to ensure the assessment is a positive experience. Case Example 1 A case example of the importance of a therapeutic assessment is when P was creating a will; P had two sons, and her husband had passed, and P was diagnosed with advanced dementia. An initial assessment was completed by a GP at their office; the GP asked questions specifically related to Banks Vs Goodfellow (1870) and completed a mini-mental state examination, with an outcome that P didn't meet the criteria. P was stressed by the interview and became tearful; her son, who had been in the room at the time, was frustrated and angry at why his mum had been asked who the prime minister was and what this had to do with her writing a will. P's son requested a second opinion, this time with the practitioner taking a therapeutic approach to the assessment. Firstly the most suitable environment for P was identified (her home) and the time (morning rather than afternoon), date and time were set, and the practitioner advised the son to remind mum of the assessment and its reason, and the practitioner's name prior to the assessment, the practitioner gained additional knowledge around P's likes and dislikes, her cultural and religious needs and built up a picture of P to allow for a better engagement. At the assessment itself, P and both sons were present; initially, the practitioner could see that both sons were frustrated from the outset and that they would not get the outcome they wanted (for P to have capacity). With consideration of the best practice approach, the practioner is able to draw upon educational and counselling theories to explain to P and, therefore, indirectly explain to her sons the legislation surrounding [capacity, the logic and reason behind completing a cognitive assessment and the outcomes of these assessments. This ensures that all involved understand the legal requirements and the reason for what could be seen as unassociated questions. The assessment itself can apply reflective tools and open questions to evidence understanding and retention of the relevant information while also creating a conversation as opposed to a clinical interview. This allows P to have a more relaxed and comfortable experience while also allowing time for her sons to witness and understand P's capacity. This assessment resulted in the same outcome for P; she lacked capacity. However, her sons were able to understand the reason why she lacked the capacity to make decisions moving forward in her best interests rather than from a place of frustration and anger. By using the assessment tool as a therapeutic tool, the outcome became the right outcome for P, although the assessment process becomes transformative for her and her family, who are better able to understand her needs and ensure these are met. Case Example 2 A further example of how a therapeutic assessment can be beneficial is in the case of a lady living with addiction disease. P was a care home resident, nonverbal and non-mobile, fully supported by her care team. An initial assessment was completed for lasting power of attorney for health and welfare, with the outcome being that P lacked the capacity for this specific decision. The assessment was completed in P's room at the care home with no other people present. The care home manager complained that the assessment was untrue and that P "had full capacity to make all her own decisions". A second opinion was sought, and the practitioner organised for the assessment to be completed at the right time for the client and to ensure her support staff and the care manager were present to ensure that communication was better supported. At the outset of the assessment, the relevant information was given to all present at the assessment and a description of the test; the practitioner then engaged directly with P. Potential attorneys were identified as family members; instead of interviewing P, the practitioner discussed family, who they were, where they lived and P's connection to them. P was unable to provide evidence of any understanding of her relationship with the prospective attorneys. The practitioner simplified the conversation to support P in her decision-making and discussed her parents; again, P was unable to provide evidence of their relationship. At this point, the care manager stepped in and asked for the assessment to be halted, as she felt it unnecessary. The care home manager explained, "We got it wrong; I didn't realise how poor her capacity had become. I think we have been allowing her to make decisions she doesn't have the capacity to make, and we should have been making decisions in her best interest. She's gone without things because she's declined them, but I don't think she understood properly." Although the outcome of the assessment was the same, the assessment's process was different, allowing for P's care team to reflect on and understand their client's abilities and needs, resulting in the right outcome for P: an increase in care support and improvements to her dignity.