The experiences of Care Coordinators using the Mental Capacity Act (2005) in secondary mental health care settings within England

Leiper, Julie and Swarbrick, Caroline and Robinson, Heather (2025) The experiences of Care Coordinators using the Mental Capacity Act (2005) in secondary mental health care settings within England. PhD thesis, Lancaster University.

Text (2025leiperphd)
2025leiperphd.pdf - Published Version
Download (1MB)

Abstract

Introduction: The Mental Capacity Act (2005) aims to empower people who may lack the capacity to make their own decisions to be engaged in their own decision-making. Since its inception, existing literature suggests that professional staff have found utilising the act difficult. These difficulties often present as challenges around practical and relational issues alongside systemic and personal difficulties. There is a need to understand the experiences of staff who work in mental health services and are required to navigate the Mental Capacity Act (MCA ) as well as the Mental Health Act (MHA) as part of their clinical work in order to support staff to provide the best care to patients. This requirement can be a challenge for some staff. Research Aim: To understand the experiences of care coordinators using the MCA within secondary mental health care. Study Method: Within this qualitative study, 10 participants with professional backgrounds in Social Work, Nursing and Occupational Therapy working as Care Coordinators within secondary mental health services from the same NHS trust were recruited. Data was collected through semi-structured interviews and analysed using Thematic Analysis (TA). Findings: The study found three themes: working in mental health; challenges and risks; learning and doing. All participants reported valuing the MCA as a piece of legislation which empowers service users to be part of their decision-making. Many challenges were reported with using and understanding the MCA with mental health service users, partly due to gaps within their knowledge. They found the nature of mental health difficulties resulted in complications when applying the MCA. Comparative to the MHA, they found the MCA ambiguous and lacking applicable clarity. Staff cited fears and concerns in relation to applying the MCA and located this within personal and emotional risks to themselves and service users on their caseload. Self-determination theory was used to explain staff motivation to engage and work with the MCA. Staff needs of autonomy, relatedness and competence were explored and grounded in their experiences and the links to psychological well-being were discussed. Conclusion: The study brings implications for clinical practice. It gave recommendations for how to improve staff experiences of using the MCA concerning training, staff support and further partnership building between service users, carers and mental health staff.