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

2009 ◽  
Vol 195 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Gareth S. Owen ◽  
George Szmukler ◽  
Genevra Richardson ◽  
Anthony S. David ◽  
Peter Hayward ◽  
...  
Keyword(s):  
Mental Health ◽  
Assessment Tool ◽  
Structured Interview ◽  
Cross Sectional Study ◽  
Mental Capacity ◽  
Best Interests ◽  
Cross Sectional ◽  
England And Wales ◽  
Mental Health Act ◽  
Mental Capacity Act

BackgroundIn 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.AimsTo 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.MethodCross-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).ResultsOf 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.ConclusionsOur 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.

Assessing mental capacity and making decisions

2019 ◽  
Vol 15 (4) ◽  
pp. 187-189 ◽  
Author(s):  
John Finch
Keyword(s):  
Mental Health ◽  
Mental Capacity ◽  
England And Wales ◽  
Mental Health Act ◽  
Mental Capacity Act 2005 ◽  
History Of ◽  
Mental Capacity Act

John Finch, a legal member of the Mental Health Act Commission for England and Wales from its creation by statute in 1983 until 1991, takes a fresh look at the uncomfortable history of the Mental Capacity Act 2005 and asks whether the Act has served any useful purpose.

scholarly journals Safeguards for informal patients

2014 ◽  
pp. 71
Author(s):  
Aswini Weereratne
Keyword(s):  
Mental Health ◽  
Mental Disorder ◽  
Residential Care ◽  
Elderly Person ◽  
Mental Capacity ◽  
Best Interests ◽  
Mental Health Act ◽  
Mental Capacity Act 2005 ◽  
Mental Capacity Act

<p>In light of the plethora of new provisions safeguarding patients who might previously have been cared for and treated informally, it may be instructive to consider who may now be considered a truly informal patient, i.e. one for whom neither process nor formality is needed. When applied to an incapacitated<br />patient requiring treatment for mental disorder, the word “informal” may now seem oxymoronic and possibly redundant. Can such a patient ever be truly informal? Part IV of the model statute suggests that an informal patient is one who lacks capacity and does not object to proposed treatment which is in their best interests, or a patient who may be treated without the use of compulsory powers; but even such a patient must now be subject to some formality if their care or treatment is to be long term or they are to be deprived of their liberty in order to ensure proper safeguards are in place.</p><p>Currently the boundary between the Mental Capacity Act 2005 (“MCA”) and Mental Health Act 1983 (“MHA”) is essentially one determined by whether the patient objects to treatment and is defined with formidable complexity in schedule 1A to the MCA. A patient eligible for MCA deprivation of liberty (“DOL”) safeguards, who could be an elderly person in long term residential care, is now subject to formal<br />processes. There is little true informality for a patient lacking treatment capacity. It is questionable whether even a capacitated patient with mental disorder, who is by definition vulnerable, may be treated informally under the MHA4 if they feel suborned into consenting by the possibility of coercion. The terminology offers a slightly deceptive impression of a benign approach with concomitant levels of<br />autonomy, but while it is appropriate to highlight a difference from compulsory process and keep formality to a minimum for the sake of informality, it is also important not to overplay formality in the name of safeguards. The latter appears to be the vice in which the MCA and MHA is now arguably gripped.</p>

scholarly journals Can the use of the Mental Health Act be the 'least restrictive' approach for psychiatric in-patients?

2016 ◽  
Vol 2016 (22) ◽  
pp. 51
Author(s):  
Beth Ranjit
Keyword(s):  
Mental Health ◽  
Legal Framework ◽  
Mental Capacity ◽  
England And Wales ◽  
Mental Health Act ◽  
Mental Capacity Act 2005 ◽  
Mental Capacity Act

<p>In England and Wales, involuntary admissions for assessment or treatment in mental health wards are based on the legal framework of the Mental Health Act 1983 (as amended in 2007) or the Mental Capacity Act 2005, with the Deprivation of Liberty Safeguards introduced in 2007. But what is the "least restrictive" approach and are we truly safeguarding in-patients’ liberty by curbing use of the Mental Health Act in particular groups?</p>

scholarly journals Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do

2020 ◽  
pp. medethics-2019-105819
Author(s):  
Dexter Penn ◽  
Anne Lanceley ◽  
Aviva Petrie ◽  
Jacqueline Nicholls
Keyword(s):  
Best Practice ◽  
Secondary Analysis ◽  
Cross Sectional Study ◽  
Mental Capacity ◽  
Capacity Assessment ◽  
Career Stage ◽  
Sectional Study ◽  
Cross Sectional ◽  
Self Confidence ◽  
Mental Capacity Act

BackgroundThe Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors’ compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors’ experiences of and attitudes toward mental capacity assessment (MCAx).MethodsThis is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.ResultsParticipants (n=92) were predominantly UK trained (82%), female (58%) and between the ages of 30 and 44 years (45%). Less than half (45%) of the participants reported receiving formal MCAx training. Only one-third (32%) of the participants self-rated themselves as very competent (29%) or extremely competent (4%). Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence (p=0.001).ConclusionsThis study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice.

Best interests provisions in the UK Mental Capacity Act 2005

2012 ◽  
Vol 36 (12) ◽  
pp. 459-462
Author(s):  
Olufunso B. Aribisala
Keyword(s):  
Decision Making ◽  
Mental Capacity ◽  
Best Interests ◽  
England And Wales ◽  
Reasonable Belief ◽  
Mental Capacity Act 2005 ◽  
Mental Capacity Act ◽  
The Uk

SummaryThe Mental Capacity Act 2005 is a critical statute law for psychiatrists in England and Wales. Its best interests provision is fundamental to substitute decision-making for incapacitated adults. It prescribes a process of and gives structure to substitute decision-making. The participation of the incapacitated adult must be encouraged where practicable. In addition to this, ‘the best interests checklist’ must be applied in every case before a practitioner can arrive at a reasonable belief that the action or decision taken on behalf of an incapacitated adult is in his best interests. Most commentators have shown goodwill towards the workings of the Act and want it to succeed.

The law relating to mental capacity and mental health

2013 ◽  
Author(s):  
Kay Wheat
Keyword(s):  
Mental Health ◽  
Mental Disorder ◽  
Health Care Professionals ◽  
Well Being ◽  
Mental Capacity ◽  
Best Interests ◽  
Decision Making Capacity ◽  
Mental Capacity Act 2005 ◽  
The Law ◽  
Mental Capacity Act

This chapter will examine two key areas of law relating to medical treatment and care of those with mental disorder. The question of decision-making capacity is important for health care professionals, and other carers and agents dealing with older people. The law relating to this is covered by the Mental Capacity Act 2005 supplemented by previous case law where this is still relevant, and the key aspect of the law is the ability to treat people without capacity in their best interests. However, in the case of some patients, it may be necessary to use the Mental Health Act 1983. This legislation is focussed, not on the capacity of the patient, but upon the effect that a mental disorder can have upon the patient risking damage to their own well-being, or to the well-being of others. The relationship between the two areas is not always clear.

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