HELPS
High-quality mental capacity assessments for healthcare decisions: improving leadership, assessment procedures and service user support (HELPS).
The HELPS study looks at how what is known as ‘mental capacity’ is assessed within the healthcare system.
Research has shown that around one in three service users in acute physical healthcare settings, and a little less than half of service users in acute mental health care settings do not have what is known as the mental capacity to take part in and consent to decisions about their health or care.
In England and Wales, the legal framework for the formal assessment of mental capacity is outlined in the Mental Capacity Act, 2005.
The Mental Capacity Act has a Code of Practice. This sets out standards that those who carry out assessments should follow.
The Code of Practice says that assessments should be criteria-focused, evidence-based, person-centred and non-judgmental.
Adults should be presumed to have capacity. They should be provided with support to make their own decisions. They should also be allowed to make an unwise decision if they have the capacity to do so.
Studies have shown that people with acute mental health and physical health problems and those with learning disabilities are at higher risk of unsatisfactory mental capacity assessment practices occurring in their care.
The aim of HELPS is to improve mental capacity assessment practices.
THE AIM OF HELPS
The aim of HELPS is to improve mental capacity assessment.
Studies have shown areas where improvements to mental capacity assessment could be made
However, making things better might be complex because improvements might need to occur at several levels
The HELPS study seeks to improve good practice through a series of stagesand work packages <weblinks to The Stages of HELPS and Work Packages webpages>
THE STAGES OF HELPS
HELPS follows a methodology called PARE. This stands for Participation, Action, Reflection and Evaluation. In the case of HELPS, this is divided into three stages:
Stage One includes interviews about current policies and practices. Researchers will talk with more than forty service leaders working in England and Wales.
Stage Two investigates how professionals do their work using semi-structured interviews, observations of practice and analysis of case notes.
This part of the study will occur in several clinical healthcare sites based in England and Wales.
Stage Three involves workshops. These will be in partnership with people such as service users, carers, professionals and managers. The aim of the workshops is to develop change to practices.
Examples of practice improvement include: helping managers create guidance documents for professionals’ work; creating a platform for training where healthcare professionals could exchange perspectives; developing accessible documents for patients and carers to explain what to expect.
WORK PACKAGES
The stages of HELPS <link to webpage on The Stages of HELPS> are divided into work packages.
Work Package 1: Understanding service policies and practices. This involves interviews with 45 service managers including individuals working within Integrated Care Systems (England) and Regional Partnership Boards (Wales), discussing and exploring current policies and practices.
Work Package 2: Assessing clinical and organisational practices based at several field sites, which represent the diverse populations of England and Wales.
This includes case note analysis and semi-structured interviews with professionals, service users and carers. HELPS researchers will also observe professionals, carers and service users on the ground in clinical settings whilst mental capacity assessments are being undertaken.
Work Package 3: Co-designing service change actions. This occurs through a series of on-site workshops at the field sites, which include service users, carers and professionals, plus three national workshops with senior leaders.
Work Package 4: Implementation and evaluation. This overarching work package informs the other work packages. It involves a Lived Experience Advisory Panel (involving service users and their carers), and the development of videos, guidance and other materials.
Please see the Panels, Groups and Committees webpage for more details. <weblink to Panels, Groups and Committees webpage>.
BENEFITS AND OUTCOMES
The goals of HELPS include improving the understanding of mental capacity and the issues surrounding it more broadly; and informing service users and carers about what best practice would look like in terms of mental capacity assessment.
HELPS involves workshops, the creation of informative materials and organised events.
These workshops and events bring professionals, commissioners and service managers together to plan improvements and share best practices regarding decision-making tools, guidance, training resources, and organisational changes, including job plans and clinical team structure.