77 Who does this guidance apply to? Adults (18+) who appear to need care or support and have mental capacity (including executive capacity) to make decisions around choice and risk and are assessed as being at risk but refuse to accept support and /or engagement with the service. When considering if an adult has mental capacity, it is important to ensure they fully understand the implications of the specific decision they are making. If there is doubt as to their understanding, a full Mental Capacity Assessment should be undertaken. Informal Carers – please note that unpaid or informal carers are entitled to an assessment even if the adult they are caring for (who is eligible for care and support) refuses any assistance. When does this Guidance apply? If an adult who has capacity refuses or declines an assessment, services or support a risk assessment must be carried out to determine the level of seriousness of each identified risk. The risk assessment will determine: What the actual risks are, including any benefits and harms The impact and the significance of the risks on the adult, other adults at risk and children who may be at risk. The adult’s ability to protect themselves Factors that increase the risk (see below) Factors that decrease the risk (see below) The likelihood of risk of future harm and likelihood of risk re-occurring Factors increasing potential risks include: Dependency on others including physical and financial dependency Difficulties in making choices due to influence from others Lack of information or access to it, not being aware of options available Issues related to language and culture Unwillingness to pay for support Lack of social support network, isolation or social exclusion Unrealistic expectation on others (services, family, partners, informal carers, neighbours etc.) Negative experiences of engagement in the past A lack of understanding of the implication of not receiving appropriate health related treatments. Factors that minimise risk may include: Positive family and/ or other close relationships Active social life and circle of friends Able to participate in the wider community Good knowledge and access to community activities Remaining independent and active A protection plan in place that remains relevant Information that is received in a timely manner and fully explains the implication of care, support or health treatments. Alongside identifying the adult's strengths and abilities, they and the professional should clarify potential difficulties and possible risks that could lead to increased dependency, harm or danger including risks to family carers or other close relationships if needs are not addressed. There may be a role in supporting their family, partner or carers, or offering other ways to meet their needs. Attempts must be made to understand the adult’s views including about any associated risks. The adult could have identified solutions not involving social care services, but
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