The British Journal of Psychiatry (2009) 195: 257-263. doi: 10.1192/bjp.bp.108.059782
© 2009 The Royal College of Psychiatrists
OPEN ACCESS ARTICLE
This Article
This is an Open Access article
Right arrow Full text (free)
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Related articles in BJP
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Owen, G. S.
Right arrow Articles by Hotopf, M.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Owen, G. S.
Right arrow Articles by Hotopf, M.

Mental capacity and psychiatric in-patients: implications for the new mental health law in England and Wales

Gareth S. Owen, MRCPsych

Department of Psychological Medicine and Psychiatry

George Szmukler, FRCPsych

Health Service and Research Department, Institute of Psychiatry, King’s College London

Genevra Richardson, LLM

School of Law, King’s College London

Anthony S. David, FRCPsych

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

Peter Hayward, PhD

Department of Psychology

James Rucker, MRCPsych

Social, Genetic, Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London

Duncan Harding, MRCPsych

Maudsley Hospital, London

Matthew Hotopf, MRCPsych, PhD

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

Correspondence: Gareth S. Owen, Department of Psychological Medicine, Institute of Psychiatry, Western Education Centre, Cutcombe Road, London SE5 9RJ. Email: g.owen{at}iop.kcl.ac.uk

Funding

The study was funded by the Wellcome Trust. M.H. and A.S.D. are supported by the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King’s College London, and The South London and Maudsley NHS Foundation Trust.

Declaration of interest

G.R. chaired the Expert Committee on the review of the Mental Health Act 1983. G.R., G.S. and A.S.D. all gave views to parliamentary committees over reform of the Mental Health Act 1983 where capacity was a central issue. These authors have differing views about mental capacity as a basis for mental health law. G.R. and G.S. are in favour of capacity-based mental health law. A.S.D. is against. M.H. has acted as an expert witness on cases where capacity has been under dispute.

Background

In England and Wales mental health services need to take account of the Mental Capacity Act 2005 and the Mental Health Act 1983. The overlap between these two causes dilemmas for clinicians.

Aims

To describe the frequency and characteristics of patients who fall into two potentially anomalous groups: those who are not detained but lack mental capacity; and those who are detained but have mental capacity.

Method

Cross-sectional study of 200 patients admitted to psychiatric wards. We assessed mental capacity using a semi-structured interview, the MacArthur Competence Assessment Tool for Treatment (MacCAT–T).

Results

Of the in-patient sample, 24% were informal but lacked capacity: these patients felt more coerced and had greater levels of treatment refusal than informal participants with capacity. People detained under the Mental Health Act with capacity comprised a small group (6%) that was hard to characterise.

Conclusions

Our data suggest that psychiatrists in England and Wales need to take account of the Mental Capacity Act, and in particular best interests judgments and deprivation of liberty safeguards, more explicitly than is perhaps currently the case.


Related articles in BJP:

Highlights of this issue
Sukhwinder S. Shergill
BJP 2009 195: A9. [Full Text]  



This article has been cited by other articles:


Home page
 Br. J. PsychiatryHome page
G. S. Owen, A. S. David, P. Hayward, G. Richardson, G. Szmukler, and M. Hotopf
Retrospective views of psychiatric in-patients regaining mental capacity
The British Journal of Psychiatry, November 1, 2009; 195(5): 403 - 407.
[Abstract] [Full Text] [PDF]