Background:
Assessments of mental capacity of people affected by acquired brain injury (ABI) can be complex to undertake and the results contested. Brain Injury Case Managers (BICM) work over the longer term with individuals affected by ABI and have experience that may inform this debate.

Aims: 
This research aimed to gain a greater understanding of the experiences and knowledge of BICMs of the issues presented by mental capacity and the application of the MCA. The intention of undertaking this research was to utilise the knowledge and experience of BICMs to inform policy makers, support improvements in the services provided to brain injured people and their relatives.

Methods: 
BICMs were asked to complete an online survey completed a questionnaire of open and closed questions. This allowed for the collection of both qualitative and quantitative data detailing BICM’s experience with brain injured clients in the last five years. 93 BICMs provided feedback re the issues they had experienced regarding capacity and assessment following ABI. A thematic analysis of the results was undertaken.

Results:
All BICMs noted that their role was to support decision-making by people affected by ABI. Conflict or difficulties with other professionals most usually arose in relation to decisions regarding welfare needs, risk taking behaviours and living arrangements. Judgements regarding “unwise” versus “incapacitous” decisions were contentious. An assessment process that failed to take account of third party knowledge, relying solely on verbal output, was criticised.

Brain injury case managers' experience of mental capacity and the UK's Mental Capacity Act: supporting decision making