Updated: Sep 22
Having your mental capacity assessed can be an intimidating experience, no matter who you are.
Even if you know why an assessment is taking place, the fear of not getting the answers ‘right’; being judged by the professional; and being asked private and personal questions can feel very overwhelming.
Conversely, if you don’t understand what is happening and cannot make sense of the situation, then you’d likely be confused by who this person is; why are they encroaching on my space; and why are they asking me these things?
For any practitioner, we want the best outcome for the patient and want to make them as comfortable as possible when completing these assessments.
However, it is not always clear, especially in the acute setting, how we can achieve this. So, here are 10 tips on how we can help reduce the stress of an assessment:
1. Get to know your patient’s needs before you assess
Now, I know this is not always easy, especially if you have only just met the patient, but utilise what information you can, in order to tailor the assessment to their needs. For example, before you go into an assessment, find out if they have any visual, auditory or communication needs that might make conversing more difficult.
For example, do they have any known triggers that could exacerbate their level of stress? Do they have a diagnosis or presenting symptoms that might impact their ability to cope with these types of environments or situations?
The more preparation you can do on how to best approach the assessment, the more likely you are to give that patient a positive experience.
2. Time it right
Think about what the patient’s day has been like. For example, have they already been assessed by three different professionals or had an intensive physio session, and have reached the upper limits of their window of tolerance before we attempt to assess?
Consider when the patient has taken their medication and if there are any side effects which could then affect their behaviour, and also if the patient suffers from sundowning.
Remember, we must assess capacity when they are at their best, so factor all these things in when deciding when to undertake the assessment.
3. Remember it’s a conversation
Some patients will hear ‘assessment’ and will think ‘test’. Many of us have felt that gut churning fear of the dreaded FAIL before going into an exam. This is a fear shared by a lot of patients when they find out they are having a capacity assessment on them.
So, being the personable, caring people, you are (after all, you would not or should not be in this industry if you aren’t!), use small talk to build a rapport and put those active listening skills to use.
4. Provide information to the patient
The 2nd principle of the MCA is crucial for so many reasons but when looking at it through the lens of reducing stress on the patient, the adage ‘knowledge is power’ applies and is particularly important for addressing the power imbalance that exists when conducting an assessment.
Always introduce yourself when you go to see them and, where possible, explain the circumstances that have resulted in the assessment being needed. Try to set expectations for what you will be discussing during the assessment, so the patient does not feel caught off guard with the nature of the questions.
If it is a complicated topic, make sure they’ve had the time to think about their options so they are not put on the spot to make a decision. Also, think about how you will present this information to the patient, depending on their needs – for example, this might be given verbally, in writing or using pictures or objects.
5. Think about the environment
This is particularly important in a busy setting.
Mental capacity assessments are often personal in nature and confidential information may need to be shared that either the patient is sensitive to or could make the patient vulnerable to others if it was overheard. So, wherever possible, try and move that assessment into a private space where the patient will be comfortable disclosing information.
Furthermore, think about whether there are any competing noises or visuals that may distract the patient or make them uneasy. Conversely, a very bare, clinical environment can also heighten anxiety, so think carefully and creatively about where you could hold these conversations.
6. Who could support the patient
If you are aware the patient is feeling stressed and intimated by the process, think about who could be brought in to support the patient through the assessment.
Remember, this must be someone who does not have a conflict of interest, and the patient must consent to them being present. If there isn’t anyone who ticks both these requirements, again think creatively and see if there is a way for someone close to the patient to be present for some aspects of the assessment, but then leave for the conversations that they cannot be privy to.
7. Keep it simple
Think about how you can phrase questions or information with terminology that the patient will understand, and avoid jargon.
When applying Tip 3 above, be careful to scaffold the relevant information so that it doesn’t feel like an overwhelming tidal wave of facts that makes them feel out of their depth in the conversation. To you, these topics may be very familiar, but for the patient, it may be the first time they are hearing it. Very importantly, do not ask them to understand more than they need to for that specific assessment.
8. Don't rush it
It’s easy to give in to all the pressures we have on our own schedules when we are overworked and time poor but remember, these assessments form the basis for potentially life changing decisions for the patient and deserve to be treated as such.
If you have an in-depth assessment, build in breaks whether this is to accommodate cognitive overload because of the emotive nature of some assessments, or even for a comfort break.
Do not wait for the patient to ask for a break, even if you said they could at the beginning of the assessment. Again, this is where the power structure comes into play. As the assessor, you are in the driving seat of the assessment and the patient may be uncomfortable grabbing the wheel, especially if it’s to accommodate their own needs. So, offer breaks throughout and be alert to any change in their emotional state. If you find yourself wanting to push through because you can see the end in sight, challenge why you are doing that and whether you are doing so at the jeopardy of the patient’s wellbeing.
If you are short on time for that visit, a second visit should always be an option you could consider.
9. Look at your non-verbals
Non-verbals tell us a lot and we need to know how to read these.
Let’s start with positioning - keep on a similar level; keep your posture open; and never stand over the patient.
Do not get in their personal space or sit head on if it can be helped, keeping chairs at a 45-degree angle is a non-oppressive position to take up – this is not an interrogation so should not feel like it.
When it comes to eye contact do not get too intense, looking at their ear with intermittent eye contact can often be a good technique. Too little eye contact can also make some people feel uncomfortable so if you must have tablet or file for note taking, make sure this does not take up all your focus.
There are always exceptions to the rules, and this harks back to Tip 1 – find out about what your patient’s needs are and what they are comfortable with.
10. Be responsive
These tips are all a good place to start, but only the patient can tell you if it works for them.
Be receptive to changing your approach based on how the patient is responding to you. The assessment is only as good as the assessor, your role is to get the best out of the patient, and nobody is ever at their best when stressed.