The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 within England and Wales as a framework for making decisions about incapacitated persons' care and treatment generally not amounting to a deprivation of their liberty (although such could be authorised under its powers by the new Court of Protection). From a planned date of April 2009, the MCA is to be enlarged by the provisions of the Mental Health Act 2007 (MHA 2007) to encompass deprivation of liberty, with the addition of a new framework of Deprivation of Liberty Safeguards (DOLS). The MHA 2007 also revised significant aspects of the Mental Health Act 1983 (MHA), which were implemented in November 2008. The interface between the MCA, as amended to include DOLS, and the revised MHA is complex and potentially ambiguous. This paper describes in detail some issues that may arise at the interface of the two acts, and seeks to inform professionals involved in the use of these legal frameworks of the resulting complexity.
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more important to service users than their psychiatrists, this does not tell us what happens in practice. The real question which we should be asking is to service users themselves and how they feel religion has been accounted for in treatment. I worry that the answers might be even more demoralising. Taking a spiritual history is both an easy and important task to be undertaken by any professional. It can substantially help a service user feel understood and hence engaged in treatment. The Spirituality Special Interest Group provides several tools which should surely become routine practice for all mental health professionals, at the very least in screening (www.rcpsych.ac.uk/PDF/ DrSEaggeGuide.pdf). The suggestion of prayer with service users is a troubling one with the potential to lead to transgression of boundaries through sharing such an intimate act. It leads to duplicity of the psychiatrist's role, erosion of the purpose of treatment and in my mind is best avoided.
<p>The Mental Capacity Act 2005 (MCA) was partially implemented in April 2007 and fully implemented in October 2007 in England and Wales (with the exception of the Deprivation of Liberty Safeguards which were implemented in April 2009). The government estimated that up to 2 million adults in England and Wales may have issues concerning their decision-making capacity (henceforth ‘capacity’), and these will included 840,000 people with dementia, 145,000 people with severe learning disability, 1.2 million people with mild to moderate learning disability and 120,000 people with severe brain injury. Additionally, the prevalence of schizophrenia, mania and serious depression are 1%, 1% and 5% respectively, and some of these individuals may also lack capacity. Moreover, up to 6 million family and unpaid carers are estimated to provide care or treatment for individuals lacking capacity. Furthermore, many other people who do not lack capacity may use aspects of the MCA for future planning.</p>
<p>The Mental Health Act Commission’s Tenth Biennial Report was laid before Parliament and published in December 2003. The report covers two years’ activity – financial years 2001 to 2003 – monitoring the operation of the Mental Health Act 1983 as it relates to the detention and treatment of patients. In twenty chapters it deals with a range of issues pertinent to the care of mental health patients subject to compulsory treatment.</p><p>I will not attempt here to list systematically the points made by our report. Readers of this journal are likely already to have thumbed a copy of the report itself, or accessed it on the Commission website, and, if not, I hope that this article will encourage them to do so. Instead, I will seek to explain in more general terms the context and themes of the report, and what we would wish to see as its desired outcome.</p>
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