Best Interests Decision Record

What is a best interests decision?

When a person lacks capacity to make a decision, someone else makes it for them. The Mental Capacity Act 2005 says that decision must be in their best interests. Section 4 of the Act sets out the steps the decision maker must follow. This best interests decision record takes you through those steps for one decision and keeps the evidence together. Use it only after a capacity assessment shows the person lacks capacity for this decision.

The record is set up for supported living services. The best interests steps do not change between settings, but the rules on deprivation of liberty do.

Filling in the record

Start with who can make the decision. If an attorney under a registered lasting power of attorney, or a deputy appointed by the court, has authority for it, record their decision and do not act against it. Check too for a valid advance decision to refuse treatment.

Then work through:

• whether the decision can wait until the person may have capacity for it

• how the person took part, and what they said or showed

• their past and present wishes, feelings, beliefs and values, including anything they wrote down when they had capacity

• the views of people consulted, such as family, carers, an attorney or deputy, and why anyone was left out

• whether an IMCA (an independent mental capacity advocate) may be needed because there is no one to consult except paid staff

• the options, with the benefits, risks and how restrictive each one is

The decision goes in Part 9, with reasons that link back to the earlier parts. Note any disagreement and how it was handled. A manager checks and signs it. A review log then tracks whether the decision is still in the person's best interests.

Restrictions and deprivation of liberty

Part 8 asks whether the chosen option restricts the person's freedom of movement or uses force they resist, and if so, whether it is necessary to prevent harm and proportionate. In supported living and home care, DoLS does not apply, so a possible deprivation of liberty goes to the local authority as a referral. Care homes follow their own DoLS process instead.

Before you use this record

Add your own record references and sign-off roles.

Part 1 asks where the capacity assessment is kept, and the Mental Capacity Assessment Form can be adapted for supported living. The referral route for supported living is in the Mental Capacity Act & DoLS Policy (Supported Living), and any change to how support is given belongs in the Care Plan Template (Supported Living).