Our ability to make decisions is a fundamental skill, and our right. However, there are circumstances in which we may lose our capacity to make decisions for ourselves. For example, if a person suffers a head injury or a stroke, or develops dementia, their memory, reasoning, and insight can be impaired. If their ability to make decisions is impaired, then they need someone to make decisions for them. But, first they must be shown to have difficulty making a decision in a specific area. Sometimes it’s obvious that they cannot make the decision, such as when they are in a coma or have severe dementia. But usually it’s unclear, and the best way to determine a person’s capacity to make decisions is to have a thorough neuropsychology assessment.

It’s not enough that you think a person may have difficulty making decisions in general. A person’s ability to make decisions is not removed by the tribunal (the Victorian Civil and Administrative Tribunal, VCAT) just because they have a disability. There has to be a specific trigger for the assessment. For example, a person has had a major stroke, and has to move out of their house into a hostel. Their house needs to be sold, but they have shown a poor understanding of the situation and have refused to sell their house and move into the hostel. In this situation, there are two triggers – the need to go into residential accommodation, and the need to sell the house, both of which they seem to show poor insight into. A neuropsychology assessment can determine whether they are making poor decisions due to cognitive impairment, or for another reason, such as life long stubbornness, a wish to die at home, etc. VCAT will only appoint a guardian to make decisions on their behalf if they are satisfied that the person has a disability, and that the disability is negatively impacting their ability to make a specific decision.

Capacity assessments are appropriate for a number of issues, such as:

Why is a neuropsychology assessment important?

A neuropsychology assessment looks not only at a person’s cognitive ability, but also how their ability to reason affects their ability to make the decision. It is a wide ranging assessment that takes into account the person’s culture, context, relationships, prior behaviour, medical conditions, medications, and their cognitive strengths and weaknesses. VCAT place great weight on the opinion in neuropsychology reports.

What happens after the assessment?

If an application for guardianship and/or administration has been made to VCAT, a copy of the report is sent to them and a hearing is held. A guardian is appointed by VCAT if the person has a disability and is at risk because they cannot make decisions about their own personal and lifestyle affairs (including medical decisions), and a decision needs to be made on their behalf. A guardian may be a family member or friend, or an independent person such as a guardian from the Office of the Public Advocate. Similarly, an administrator (someone to manage financial affairs) is appointed if the person has a disability and is at risk because they cannot manage their own financial or legal affairs, and a decision needs to be made on their behalf. Again the administrator can be a family member or friend, or an independent person, usually from State Trustees. Appointments can be temporary and are regularly reviewed.