Assessing the mental capacity of special care patients requiring dental treatment

No one can sign for dental treatment on behalf of adults. This should be emphasized with special care people who lack mental capacity. A criminal offence concerning ignorance or ill treatment of people who lack mental capacity could be the result (British Society for Disability and Oral Health, 2000). Adult special care people who have a mental health illness, stroke, confusion, dementia, Parkinson’s disease or severe learning disability may lack the mental capacity to make their own decisions about their dental care and treatment. Therefore, it was indeed required to use a tool/measure to assess their mental capacity prior to taking a decision. Consequently, a valid consent form should be obtained and documented. An informed consent should aim to provide enough information about potential risk factors and benefits of the planned dental treatment, ensure that the patient understands the information given, ensure that the decision is made by the patient, and include an obligation to respect the patient’s decision (Dougall and Fiske, 2008). The Mental Capacity Act 2005 was designed to assist patients who may lack mental capacity (adults > 16 years) and to discourage anyone responsible for their care such as family members, carers or guardians from taking any decision on behalf of the patient (Mental Capacity Act, 2005). This act works by assessing four crucial criteria based on five principles.

Five statutory principles have been recognised and should be given consideration before assessing a patient’s mental capacity: (1) Presumption of capacity, unless it is established that the patient lacks capacity; (2) provision of support to make a decision; (3) the right to make unwise decisions; (4) the requirement to act in the person’s best interest, and lastly; (5) consideration to make the least restrictive intervention.

Following understanding of these five statutory principles, the Mental Capacity Act 2005 has two stages to help assess the mental capacity of people who may lack capacity. The first stage aims to assess if the person has an impairment of their mind or brain. Subsequently, the second stage aims to assess if the impairment of their mind or brain influences the person’s decision negatively when they need. The Mental Capacity Act 2005 recommends four crucial criteria to help decide if the patient has mental capacity or lack of mental capacity to decide. The patient is unable to make a decision if she/he cannot: (1) Understand information related to the decision to be made, potential risks, and benefits; (2) retain that information in their mind; (3) use or weigh up that information as part of the process of building the decision and lastly; (4) communicate their decision using any method of communication.

However, if the person lacks mental capacity after following all of the above stages, a meeting should be designated to decide on their behalf. Dental care providers, and the patient’s carer, guardian or next of kin should be involved in helping develop a decision in the patient’s best interests. When taking such a decision, all people involved in the decision should consider four important points to help them decide the patient’s best interest: (1) People are treated as individuals; (2) they have to consider any past thinking or decision by the patient; (3) the decision-maker has taken into account the views of the people involved in the meeting, and lastly; (4) the views of the people consulted by the decision-maker are taken into account. However, if the person who lacks capacity does not have family or anyone who can help to decide on their behalf, the independent mental capacity advocates (IMCAs) should be followed (Dougall and Fiske, 2008).

The mental capacity assessment tool is not difficult to practise in dentistry, but it requires training and logistical support by an organization with high authority to be implemented. This helps to protect special care patients’ rights and dignity.

Conflict of interest

The author declared that there is no conflict of interest.