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Mental capacity in psychiatric patients

Systematic review

South London and Maudsley NHS Trust, and Academic Department of Psychological Medicine, Institute of Psychiatry, London

GARETH OWEN, BSc, MRCPsych

Academic Department of Psychological Medicine, Institute of Psychiatry, London

HUGH McGUIRE, MSc

Health Service and Public Health Research, Institute of Psychiatry, London

SWARAN SINGH, MD, FRCPsych, DM

Health Sciences Research Institute, University of Warwick

RACHEL CHURCHILL, MSc, PhD

Health Service and Public Health Research, Institute of Psychiatry, London

MATTHEW HOTOPF, MSc, PhD, MRCPsych

Academic Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK

Correspondence: Professor Matthew Hotopf, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. Tel: +44 (0) 20 7848 0778; fax: +44 (0) 20 7848 5408; email: m.hotopf{at}iop.kcl.ac.uk

Declaration of interest None.

Background Mental capacity is central to legal and ethical debates on the use of compulsion in psychiatry.

Aims To describe the clinical epidemiology of mental incapacity in patients with psychiatric disorders, including interrater reliability of assessments, frequency in the psychiatric population and associations of mental incapacity.

Method Cross-sectional studies of capacity to consent to treatment for psychiatric patients were systematically reviewed from Medline, EMBASE and PsycInfo databases. Information on the reliability of assessments, frequency and associations of mental incapacity was extracted.

Results Out of 37 papers reviewed, 29 different capacity assessment tools were identified. Studies were highly heterogeneous in their measurement and definitions of capacity. Interrater reliabilities between tools were high. Studies indicate incapacity is common (median 29%) but the majority of psychiatric in-patients are capable of making treatment decisions. Psychosis, severity of symptoms, involuntary admission and treatment refusal were the strongest risk factors for incapacity.

Conclusions Mental capacity can be reliably assessed. The majority of psychiatric in-patients have capacity, and socio-demographic variables do not have a major impact but clinical ones do.

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