The CURE Test

A short BLOG on something which I think provides a very useful tool for police officers – for that matter, many other professionals – to consider how to approach the issue of ‘capacity’ when vulnerable people are making decisions.  This was originally drawn to my attention by @meditude on Twitter and I’m very grateful for that.

It has since been slightly added to after feedback from MCA trainer @mattgrahamdrum.

It is simple to consider and easy to remember.

The “ID A CURE” Test means –

  • Impairment – is there an impairment (temporary or premanent) which prevents the person from being able to ‘CURE’, as below; OR
  • Disturbance – is there an disturbance of the mind (temporary or premanent) which prevents the person from being able to ‘CURE’, as below; OR

AND – only one of the follow factors need be satisfied for the person to lack capacity

  • Communicate – can the person communicate their decision to you (even if not verbally)?
  • Understand – can the person understand the information that would enable them to make the decision?
  • Retain – can the patient retain the information in order to make the decision?
  • Employ – can the patient employ the information to make the decision effectively?

The Mental Capacity Act invites consideration of whether someone, in fact, has capacity to take certain decisions for themselves and as a precussor to decisions about whether / what may be in someone’s best interests, if it is believed that they lack capacity.  The Code of Practice to the Act does make clear that such considerations do not require a ‘scientific’ level of reasoning or evidence – but it does require evidence of a thoughful (enough) approach against presumption of capacity.

It should be remembered: the fact that someone’s decision may be considered ‘unwise’ is not in itself sufficient to assume that they lack capacity.  People may take decisions to self-harm, decline medical treatment and so on.

Reminder – police officers, wherever they possibly can, should defer decision-making around mental capacity to healthcare professionals.  The ambulance service – from whom this mnemonic is “borrowed with pride” – have better training than police officers around this business and the CoP MCA requires it.  It may also be possible or necessary to contact mental health crisis services or out of hours GPs, depending on circumstances.

For more information, read my main blog on The Police and the Mental Capacity Act.

Police intervention should be restricted to the circumstances outlined in s4B MCA – only where intervention is necessary to mitigate an immiment, life-threatening risk where delay would leave the incapacitated person exposed to the risks officers have identified.

______________________________________________________________________
The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs

ccawards2013 was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.

 

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11 thoughts on “The CURE Test

    1. Good isn’t it!? I like a lot because it’s simple – like me and most cops.

      Looking forward later to a good MCA trainer’s feedback on it as I’ve asked for his view.

      Will let you know – hope you’re well?

  1. Its good although I’m aware of situation when all those tests have been passed and the psychs or GP using a social worker insist on detainment.

    While Police officers insist is no reason to detain, but once the paperwork is signed off that person goes to the ward for a lifetime of negative change.

    And some folk ask a reason why people see parity with Adolf Hitler and those psychs that initiated the holocaust.

    End invasive emergency detention & compulsory treatment order, end the slavery, down with the monopoly of no method of action, no cure when ways exist.

  2. My partner is a Paramedic and I have to disagree about them getting better training. I still turn out to jobs where I’m told people have failed a capacity test based solely on the fact the patient doesn’t want to go to hospital.

    The last set of shifts I was turned out to a call by the ambulance service where a female was threatening suicide. The female was depressed and explained clearly that she wanted to die as well as understanding the consequences. She had made no attempts to do so and wasn’t aggressive. The grief I had convincing a Paramedic and then Advanced Paramedic that there was nothing I could do and that wanting to commit suicide isn’t a reason to fail a capacity test (Kerrie Wooltorton). In the end I arranged a MH assesmemt at her home and left the crew to wait with her.

    I have my own 3 stage test when dealing with the MCA and the use of force:

    1) Does the person lack capacity?:
    It’s not that difficult in most cases to answer and is based on you’re CURE. NOT on the decision made being seen as stupid.

    2) Is there an injury,is it life threatening and treatment needed immediately?:
    If its not that serious why the rush. Should a 6ft 2in 17st cop really be dragging an old dear with dementia out of her house because she’s grazed her knee falling over? If there’s enough time to get a judge to make a decision let them make that call.

    3) Is there an easier way?:
    Why should I drag a self harmer out of their house when a nurse could attend a stitch the minor cuts? It is after all one of the 5 principles of the MCA codes of practice.

    If the situation fails one of these three test then I don’t use force.

    1. Sounds spot on to me … just to come back on the ‘better training’ remark: we got none at all on MCA. Ambo in this area all get some and a few get a decent amount. Local variation thing, but this is also true in some other areas I’m aware of … obviously not in yours, though!

      1. They get the training but not how to use it practically. Adding to this confusion that it regularly clashes with their own policies and it can get difficult. My wife has just completed the Law and Ethics section of a Paramedics Siences Diploma and she was shocked at how little she knew about her own liability and how many laws get broken through poorly though out policies.

        What was interesting was an input she received from a nurse with legal training. Apparantly the MCA is the main reason NHS trusts are paying out compensation at the moment so it’s only time until it starts happening to Police forces.

  3. What strikes me under CURE is how anyone is ever judged to have capacity! I don’t think I’d pass mySELF as capable most of the time. It’s a high bar!

    1. LOL! There is a legal presumption of capacity – no-one needs to be passed as capacitious, it is the presumption til the opposite is shown.

      Does that help you declare yourself ‘capacable’?!

      1. 17 May 2012
        Dear Mentalhealthcop
        In my opinion the MCA2005 is a very poor law because it is widely misinterpreted.
        Kate Lumsden, barrister, has warned prosecutors who are seeking to prosecute under Section 44 of the MCA2005 – and I believe she is right.
        Apart from anything else, there are many variations on what is a “vulnerable person”.
        Technically, any patient in hospital is “vulnerable” by the very nature of being a patient, but not all patients automatically would come under the MCA2005 unless of course they are incapacitous.
        But maybe their incapcitousness is linked to being ill, or comatose or even, perhaps being very sleepy on account of being drugged.
        These people are not incapacitous per se, but only temporarily.
        And hence the problem.
        How do police work out forensically if a person was or was not capacitous retrospectively?
        A very tall order, I would say.
        And the wisdom of Solomon required to ensure fairness and justice to a carer or family member who might be charged under such Section 44 for a person who may have acted in an unwise manner or even self-neglected.
        In 2011 the Isle of Wight Coroner brought in a verdict of self-neglect by a person who was known to have mental health issues and had determined she wanted to follow her own wishes. The Social Worker and Psychiatrist were told they were not to blame for her death. And I think that just because a person has mental health disorders – even serious ones such as schizophrenia and post-traumatic stress syndrome – should be allowed to have a choice as to what they want to do, and that they should be encouraged to find out what they want to do, and not be forced to do what others choose.
        The issue of suicide is of course major. And I pity everyone in such a situation.
        With best wishes and thank you so much for your kindness in helping us all,
        Rosemary

    1. Dear Mentalhealthcop and Richard Pilberry

      I am very intrigued by the idea of “UR a WC” as it seems to have alternative connotations. If someone said that to me, I would automatically quiz them on account of it being “water closet”!
      I would actually think the person saying it was round the bend – or maybe is that round the u-bend!?

      Joking apart, this does seem a good idea.

      I note that there is to be a major training of police upcoming this autumn regarding mental health issues.

      Best wishes

      Rosemary
      Rosemary Cantwell

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