Mental capacity and diet, weight and health

Briony Caffrey introduces a new course developed by the BDA Mental Health Specialist Group which aims to provide practitioners working with people who might lack capacity and have dietetic needs with essential knowledge on the Mental Capacity Act.

It has long been documented that people with learning disabilities are more likely to experience health inequalities and healthcare inequalities which contribute towards premature and avoidable deaths (Forssmann et al, 1970; Mencap, 2007; LeDeR, 2022). The Learning Disability Mortality Review report from 2023 shows for the first time that the leading cause of death is diseases of the circulatory system. Previously, respiratory diseases have always posed the most risk (LeDeR, 2021). We are at a turning point: more must be done to understand the increased risks associated with circulatory health in this population.

Circulatory system diseases may be better understood as cardiovascular disease (CVD), an umbrella term which includes all diseases of the heart, blood vessels and circulation. CVD may present as atherosclerosis with increased risk of blood clots, high blood pressure and poor circulation to organs and limbs, which reduces function and can lead to heart attacks and strokes (NHS, 2022).

There are several modifiable risk factors, including smoking, low high-density lipoprotein (HDL) cholesterol, high non-HDL cholesterol, sedentary lifestyle/lack of physical activity, unhealthy diet, more than 14 units of alcohol per week, and overweight and obesity (NICE, 2023).

NHS Digital Data 2022 shows significantly greater rates of obesity in those with a learning disability compared with the rest of the population. In the age range of 18-24-year-olds, 20.2% of the learning disability population experience obesity compared with 3.4% of the rest of the population. This is a sixfold difference.

Further considerations need to be given to a range of issues affecting weight and diet when working with the learning disability population, one of which is the matter of capacity (PHE, 2020). Difficulties cited include balancing ‘choice and the duty of care’ as well as ‘supporters misusing the right to make unwise decisions as an excuse for not helping the person to understand risks and options properly’ (PHE, 2020).

Poor application of the Mental Capacity Act (MCA) 2005 is echoed in the LeDeR 2022 and CIPOLD 2014 reports this as a contributing factor to poor health outcomes. The evidence is clear and points towards a need to better understand and apply the MCA to improve quality and length of life. The role of clinicians in understanding the importance of capacity is further defined in the updated HCPC Standards of Proficiency regarding ‘practice within legal and ethical boundaries’. We need to bring the issues of capacity central to the way we support diet and weight.

The BDA Mental Health Specialist Group has developed a new course – Assessing Capacity Regarding Diet, Weight and Health – in response to the growing prevalence and identified need. The course uses a range of activities to deepen understanding of application in practice including case studies and group discussions. It is open to all practitioners working with people with learning disabilities and other vulnerable groups, who would benefit from diet and weight-related capacity assessments.

By the end of the course, delegates will be able to understand the MCA, consider how this applies to diet, weight and health, understand when to complete a capacity assessment on these decisions, understand who can (and how to) complete a capacity assessment, and how to respond to the outcome. You will receive a pack which you can use in your practice and to support change for the people you work with.

The first roll-out of the course will take place on Wednesday 17 January 2024. As the course is open to all practitioners working with people who would benefit from a capacity assessment relating to these decisions, you are invited to share the booking link with interested colleagues.

Register your interest online.

References

1. Forssmann, H. Akesson, HO.  (1970) ‘Mortality of the mentally deficient: a study of 12,903 institutionalised subjects’ The Journal of Intellectual Disability Research. Volume14 (4) Pages 276-294. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2788.1970.tb01127.x (Accessed: 16/9/23)
2. Health and Care Professions Council (HCPC) (2023) The standards of proficiency. 2. Practice within the legal and ethical boundaries of their profession. Available at: URL https://www.hcpc-uk.org/standards/standards-of-proficiency/dietitians/  (Accessed: 15/9/23).
3. Heslop, P. Blair, P. Fleming, P. Hoghton, M. Marriott, A. Russ, L (2014) ‘The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study’, The Lancet, Volume 383, (9920), Page 889-895. Available at: https://doi.org/10.1016/S0140-6736(13)62026-7 (Accessed:16/9/23)
4. LeDeR Team (2021) The LeDeR Programme Annual Report 2020.  Available at: URL https://leder.nhs.uk/images/annual_reports/LeDeR-bristol-annual-report-2020.pdf  (Accessed: 15/9/23).
5. LeDeR (2022). ‘Learning from Lives and Deaths - People with a learning disability and autistic people (LeDeR) report for 2021. Available at: URL  https://www.kcl.ac.uk/ioppn/assets/fans-dept/leder-main-report-hyperlinked.pdf  (15/9/23).
6. LeDeR (2023). ‘Learning from Lives and Deaths - People with a learning disability and autistic people (LeDeR) report for 2022. Available at: https://www.kcl.ac.uk/research/leder (22/10/23).
7. Mencap (2007) Death by indifference. London. Available at: https://www.basw.co.uk/system/files/resources/basw_121542-4_0.pdf (Accessed: 16/9/23)
8. NHS (2022) Cardiovascular disease. Available at: https://www.nhs.uk/conditions/cardiovascular-disease/ (Accessed: 16/9/23)
9. NHS Digital (2022) Health and Care of People with Learning Disabilities, Experimental Statistics, 2017 2018 to 2021 2022. Page 3. Available at: URL https://app.powerbi.com/view?r=eyJrIjoiNTYyNDM4MGYtZDRmYi00NTAxLTkzY2QtMjcwZTY2YTQ0MzNkIiwidCI6IjUwZjYwNzFmLWJiZmUtNDAxYS04ODAzLTY3Mzc0OGU2MjllMiIsImMiOjh9  (Accessed: 15/9/23).
10. NICE (2023) CVD risk assessment and management: What are the risk factors? Available at: https://cks.nice.org.uk/topics/cvd-risk-assessment-management/background-information/risk-factors-for-cvd/ (Accessed: 16/9/23)
11. Public Health England (2020) Obesity and weight management for people with learning disabilities: guidance. Available at: https://www.gov.uk/government/publications/obesity-weight-management-and-people-with-learning-disabilities/obesity-and-weight-management-for-people-with-learning-disabilities-guidance (Accessed on: 15/9/23)