Abstract
Background Determining the mental capacity of psychiatric patients for making decisions regarding treatment acceptance or refusal is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make well-founded medical care decisions. Methods Systematic review of literature review articles following PRISMA recommendations. PubMed, Scopus and CINAHL were electronically searched up to 30 September 2019. Free text searches and medical subject headings in English were combined. Publications were selected as per inclusion and exclusion criteria. The AMSTAR 2 tool was used to assess the quality of reviews. Results Thirteen publications were reviewed. In one review, up to 67% of patients in a mixed psychiatric population had capacity to decide about admissions; 71% (median) had capacity for making decisions about treatments. In another, community-dwelling or clinically stable psychiatric outpatients were close to non-psychiatric subjects in decision capacity performance. In a third review, people with psychosis had moderately impaired risk-reward decision-making ability compared with healthy individuals (g =-0.57, 95% CI: -0.66 to -0.48; I 2 45%), and were more likely to value rewards over losses (k = 6, N = 516, g = 0.38, 95% CI 0.05 to 0.70, I 2 64%) and to base decisions on recent rather than past outcomes (k = 6, N =516, g = 0.30, 95% CI: -0.04 to 0.65, I 2 68%). In a fourth review, future care (crisis) planning led to a 40% reduction in the use of compulsory inpatient treatment over 15 to 18 months. In other reviews, patients with mental illness were able to provide valid preference measures and gave sufficiently consistent answers regarding their preferred treatments. Decision-making responded favourably to interventions. The publications complied satisfactorily with the AMSTAR 2 critical domains. Conclusions Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder are able to make rational decisions about their care. Best practice strategies should help mentally ill patients grow into voluntary and safe users of medications, enabling them to keep a sense of control over their lives and enhancing their health-related quality of life.
Newspaper Articles Related to the Not Criminally Responsible on Account of Mental Disorder (NCRMD) Designation: A Comparative Analysis
