The impact of the 2005 Mental Capacity Act on social workers' decision making and approaches to the assessment of risk

The 2005 Mental Capacity Act in England and Wales has introduced a statutory regime for assessment and best interests substituted decision making for people lacking the capacity to make autonomous decisions. This includes decision making by older people with dementia. Based on empirical research into the early impact of the Act on social work practice, three distinct types of approach to risk emerged: legalistic, actuarial and rights-based. Understanding of these three types is discussed in the context of modernist assumptions of rationality and self-interest, the demands of a ‘risk society’ for adeptness at decision making and the relationship between moral and legal discourse where social workers intervene when capacity is challenged. Outcomes are discussed for their relevance to the changing context of social work with people with dementia, the introduction of individual budgets replacing directly provided services and the development of a National Dementia Strategy. Though risk-based and actuarial types dominated actual practice, rights-based approaches are argued to be necessary to support older people in making choices and exercising citizenship, countering stereotypes and promoting well-being.