Prevalence and predictors of mental incapacity in psychiatric in-patients

Ruth Cairns · Clementine Maddock · Alec W. Buchanan · Anthony S. David · Peter Hayward · Genevra Richardson +2 more

165 citations0/0 files storedThe British Journal of Psychiatry

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Healthcare Decision-Making and Restraints Ethics and bioethics in healthcare Health, Medicine and Society

Abstract

BACKGROUND: Little is known about the proportion of psychiatric in-patients who lack capacity to make treatment decisions, or the associations of lack of capacity. AIMS: To determine the prevalence of psychiatric in-patients who lack capacity to make decisions about current treatment and to identify demographic and clinical associations with lack of mental capacity. METHOD: Patients (n=112) were interviewed soon after admission to hospital and a binary judgement of capacity was made, guided by the MacArthur Competence Tool for Treatment. Demographic and clinical information was collected from an interview and case notes. RESULTS: Of the 112 participants, 49 (43.8%) lacked treatment-related decisional capacity. Mania and psychosis, poor insight, delusions and Black and minority ethnic group were associated with mental incapacity. Of the 49 patients lacking capacity, 30 (61%) were detained under the Mental Health Act 1983. Of the 63 with capacity, 6 (9.5%) were detained. CONCLUSIONS: Lack of treatment-related decisional capacity is a common but by no means inevitable correlate of admission to a psychiatric in-patient unit.

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1993Training and quality assurance with the Brief Psychiatric Rating Scale: "The drift busters."1997The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions 1995The MacArthur Treatment Competence Study. III: Abilities of patients to consent to psychiatric and medical treatments.2004Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study 1993Two scales for measuring patients' perceptions for coercion during mental hospital admission 1995Comparison of standards for assessing patients' capacities to make treatment decisions

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