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

1. Stage 1: Diagnostic Test

Is there an impairment of, or disturbance in, the functioning of the mind or brain?

2. Stage 2a: Understand

Can the person understand the information relevant to the decision?

3. Stage 2b: Retain

Can the person retain the information long enough to make the decision?

4. Stage 2c: Use or Weigh

Can the person use or weigh the information as part of the decision-making process?

5. Stage 2d: Communicate

Can the person communicate their decision (by any means)?

6. 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\
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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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