Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study

doi:10.1136/bmj.39580.546597.BE

Research

Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study

Gareth S Owen, clinical researcher¹, Genevra Richardson, professor of law², Anthony S David, professor of cognitive neuropsychiatry¹, George Szmukler, professor of psychiatry and society³, Peter Hayward, consultant clinical psychologist⁴, Matthew Hotopf, professor of general hospital psychiatry¹

¹ Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King’s College London, London SE5 8AF, ² School of Law, King’s College London, ³ Department of Health Services and Population Research, Institute of Psychiatry, King’s College London, ⁴ Maudsley Psychology Centre, Maudsley Hospital, London

Correspondence to: M Hotopf m.hotopf{at}iop.kcl.ac.uk

Objective To estimate the prevalence of mental capacity to makedecisions on treatment in people from different diagnostic andlegal groups admitted to psychiatric hospital.

Design Cross sectional study.

Setting General adult acute psychiatric inpatient units.

Participants 350 consecutive people admitted to psychiatricwards from the community over 16 months.

Main outcome measure Mental capacity assessed by clinical interviewand the MacArthur competence assessment tool for treatment.

Results Estimates of mental capacity were obtained on 97% (n=338)of the 350 people admitted. Of those an estimated 60% (95% confidenceinterval 55% to 65%) lacked mental capacity to make decisionson treatment. This proportion varied according to diagnosis,ranging from 97% (n=36) in people with mania to 4% (n=24) inpeople with personality disorder. Mental incapacity was commonin patients admitted informally to the psychiatric wards (n=188;39%, 32% to 46%). Incapacity and detention are closely associatedunder non-capacity based mental health law.

Conclusions Mental incapacity to make decisions on treatmentis common in people admitted to psychiatric wards from the communitybut cannot be presumed. It is usual in those detained underthe Mental Health Act and common in those admitted voluntarily.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to StumbleUpon StumbleUpon Add to Technorati Technorati What's this?

Relevant Articles

Who decides on treatment for mental illness?: Sahoo Saddichha
BMJ 2008 337: a899. [Extract] [Full Text]

Trustwide audit on mental capacity: Gaurav Mehta and Alex Phipps
BMJ 2008 337: a901. [Extract] [Full Text]

Clarification of mental capacity and psychiatric admission: Brian Murray
BMJ 2008 337: a917. [Extract] [Full Text]

Mental capacity and psychiatric admission: John Dawson
BMJ 2008 337: a116. [Extract] [Full Text]

This article has been cited by other articles:

(2008). High Incidence of Decision-Making Incapacity in Hospitalized Psychiatric Patients. JWatch Emergency Med. 2008: 5-5 [Full text]
Saddichha, S. (2008). Who decides on treatment for mental illness?. BMJ 337: a899-a899 [Full text]
Mehta, G., Phipps, A. (2008). Trustwide audit on mental capacity. BMJ 337: a901-a901 [Full text]
Murray, B. (2008). Clarification of mental capacity and psychiatric admission. BMJ 337: a917-a917 [Full text]
Dawson, J. (2008). Mental capacity and psychiatric admission. BMJ 337: a116-a116 [Full text]

Rapid Responses:

Read all Rapid Responses

Treatment for mental illness: Who decides?: Sahoo Saddichha
bmj.com, 6 Jul 2008 [Full text]
Mental capacity, a dynamic process:: Ignasi Agell, et al.
bmj.com, 9 Jul 2008 [Full text]
Assessment and Interpretation of Mental Capacity is indeed a Complex Process!: Nitin Gupta, et al.
bmj.com, 10 Jul 2008 [Full text]
Trustwide Audit on Mental Capacity assessment and documentation: GAURAV MEHTA, et al.
bmj.com, 10 Jul 2008 [Full text]
Mental Capacity, diagnosis and insight: Matthew Hotopf, et al.
bmj.com, 16 Jul 2008 [Full text]
Presuming mental capacity and admission: Rajeswari Venkatesan
bmj.com, 4 Aug 2008 [Full text]
Specifying Decisions: Matthew Hotopf, et al.
bmj.com, 7 Aug 2008 [Full text]