Reliability of mental capacity assessments in psychiatric in-patients

Cairns, Ruth; Maddock, Clementine; Buchanan, Alec; David, Anthony S.; Hayward, Peter; Richardson, Genevra; Szmukler, George; Hotopf, Matthew

doi:10.1192/bjp.187.4.372

Cited by 123 publications

(108 citation statements)

References 19 publications

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“…10 Another study revealed that 44% of psychiatric in-patients lack treatment-related decisional capacity and out of these 17% fell in the 'Bournewood gap'. 11 We are currently not aware of any similar study in learning disability psychiatric in-patient units but it is expected that the number of incapacitated patients admitted informally would be higher compared with other specialties.…”

Section: Discussionmentioning

confidence: 99%

Mental Capacity Act 2005: views and experiences of learning disability psychiatrists

Sawhney¹,

Mukhopadhyay²,

Karki³

2009

Psychiatr. bull.

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competencies across specialties for working in niche super-specialised areas. Any such provision needs to be structured to protect the value of the CCT and should have the quality assurance processes of pre-CCT training posts. Post-CCT training should not dilute the increasing importance of continuing professional development within the consultant grade. ConclusionIt is clear that there are specialty combinations that remain crucial to service provision and appropriate training must therefore exist to ensure that there are specialists in these areas. However, traditional dual training appears to be under threat and adaptations need to be made to the new structure of postgraduate training to allow trainees to develop the necessary competencies across specialties. The rhetoric surrounding MMC promised greater flexibility of training and it is of paramount importance that this is developed in order for trainees to achieve the broad and diverse range of competencies that are required by these developing services. This will allow us to meet the needs of our patients and deliver the best possible care.

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Section: Discussionmentioning

confidence: 99%

Mental Capacity Act 2005: views and experiences of learning disability psychiatrists

Sawhney¹,

Mukhopadhyay²,

Karki³

2009

Psychiatr. bull.

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“…We found that the overall level of agreement between all professionals who rated the case vignettes was slight. This suggests that, in contrast to mental capacity which can be reliably assessed, 14 current approaches used to identify deprivation of liberty do not lead to reproducible and reliable outcomes.…”

Section: Main Findingsmentioning

confidence: 98%

Judgements about deprivation of liberty made by various professionals: comparison study

et al. 2011

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Aims and methodA group of lawyers, psychiatrists, best interest assessors and independent mental capacity advocates were asked to make binary judgements about whether real-life situations in 12 vignettes amounted to deprivation of liberty. Kappa coefficients were calculated to describe the level of agreement within each professional group and for the total group of professionals.ResultsThere was total agreement between all professionals about deprivation of liberty in only 1 of the 12 cases. The overall level of agreement for judgements made by all professionals was ‘slight’ (κ=0.16, P < 0.01).Clinical implicationsThere are practical difficulties involved in making reliable deprivation of liberty judgements within the Deprivation of Liberty Safeguards (DoLS) legislation. A clear interpretation of deprivation of liberty is necessary to facilitate professionals' decision-making in this area.

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“…In a study by Cairns et al (2005), of 112 participants, 49 (44%) lacked treatment-related decisional capacity. Out of these, 30 were detained under the Mental Health Act 1983 and 19 (17%) fell into the Bournewood gap.…”

Section: Discussionmentioning

confidence: 99%

“…Many patients who do not have capacity to consent are given hospital treatment informally both in the medical and psychiatric setting (Raymont et al, 2004;Cairns et al, 2005) and it is argued that their rights are not protected. Protecting the rights of in-patients with mental illness who lack capacity to consent was highlighted in England by the Bournewood case (L. v. Bournewood Community and Mental Health NHS Trust [1998]).…”

Section: The Bournewood Judgmentmentioning

confidence: 99%

Assessment of mental capacity: who can do it?

Singhal¹,

Kumar

Belgamwar

et al. 2008

Psychiatr. bull.

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Aims and MethodsTo determine the point prevalence of mental incapacity and the ‘Bournewood gap’ in general adult and old age mental health in-patients. The correlation of mental capacity assessment between doctors and nurses was investigated. Data were gathered on one census day for all general adult and old age psychiatric in-patients at three hospital sites.ResultsHalf the sample lacked capacity and one third fell into the ‘Bournewood gap’. The capacity assessment by nurses and doctors correlated highly (κ=0.719, P=0.0001).Clinical Implications‘Bournewood gap’ patients should have their needs assessed in order to identify and protect their rights. Appropriately trained mental health nursing staff can undertake this assessment.

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Reliability of mental capacity assessments in psychiatric in-patients

Abstract: In combination with a clinical interview, the MacCAT-T can be used to produce highly reliable judgements of capacity.

Cited by 123 publications

References 19 publications

Mental Capacity Act 2005: views and experiences of learning disability psychiatrists

Mental Capacity Act 2005: views and experiences of learning disability psychiatrists

Judgements about deprivation of liberty made by various professionals: comparison study

Assessment of mental capacity: who can do it?

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