CASC Capacity Assessment Stations
Capacity assessment stations are high-yield in the CASC exam. Learn the legal framework and clinical approach that examiners are looking for.
Overview
Mental capacity assessment is a frequently tested and high-yield topic in the CASC exam. Stations may ask you to assess a patient's capacity to consent to treatment, refuse admission, make financial decisions, or other specific decisions. You must demonstrate understanding of the legal framework (Mental Capacity Act 2005), apply the two-stage test, and communicate your findings clearly.
Key Skills Assessed
- Understanding the Mental Capacity Act 2005 principles
- Applying the two-stage capacity test
- Assessing the four functional criteria
- Determining decision-specific capacity
- Documenting capacity assessments clearly
- Managing situations where capacity is lacking
Recommended Framework
Stage 1: Diagnostic Test
Is there an impairment of, or disturbance in, the functioning of the mind or brain?
Stage 2a: Understand
Can the person understand the information relevant to the decision?
Stage 2b: Retain
Can the person retain the information long enough to make the decision?
Stage 2c: Use or Weigh
Can the person use or weigh the information as part of the decision-making process?
Stage 2d: Communicate
Can the person communicate their decision (by any means)?
Document & Decide
Record findings, state capacity decision, and if lacking capacity, proceed to best interests
Example Exam Scenarios
Assess capacity to consent to antipsychotic medication in a patient with schizophrenia
Assess capacity to refuse hospital admission in a patient with mania
Assess capacity to make a will (testamentary capacity) in a patient with early dementia
Assess capacity to consent to ECT in a patient with severe depression
Common Mistakes to Avoid
- ✕Treating capacity as "all or nothing" — it's always decision-specific
- ✕Not explaining the information before testing understanding
- ✕Forgetting the principles: assume capacity, support decision-making, unwise decisions ≠ incapacity
- ✕Not documenting the assessment clearly
- ✕Failing to mention best interests if capacity is lacking
Examiner Tips
- Always start by assuming capacity — then assess systematically
- Explain the relevant information clearly before testing whether they understand it
- Use open questions to test understanding: "Can you tell me in your own words...?"
- Remember: an unwise decision does not equal lack of capacity
- If capacity is lacking, explain the best interests framework and next steps
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