Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study

Mandarelli, Gabriele; Carabellese, Felice; Parmigiani, Giovanna; Bernardini, Francesco; Pauselli, Luca; Quartesan, Roberto; Catanesi, Roberto; Ferracuti, Stefano

doi:10.1017/s2045796017000063

Cited by 72 publications

(31 citation statements)

References 34 publications

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“…Patients treated voluntarily scored considerably better than those treated involuntarily in all MacCAT‐T subscales and were more able than those admitted involuntarily to understand, appreciate, and reason about their own clinical condition, the risks, and benefits of treatment, and to express a clear treatment choice 32 . A subsequent study by the same authors found that 22% (n = 29) of 131 patients with an acute psychotic episode involuntarily hospitalized and treated also had high treatment decision‐making capacity, defined as scoring above 75% of the maxima in all four MacCAT‐T subscales 33 . Likewise, a study by Brown et al 21 reported that 67.1% (95% CI: 63.1‐71.0) of schizophrenia; 60.8% (95% CI: 54.9‐66.7) of schizoaffective/other psychotic and 69.0% (95% CI: 63.0‐75.0) of bipolar disorder patients were assessed to lack capacity at psychiatric admission according to the Mental Capacity Act 2005 criteria.…”

Section: Resultsmentioning

confidence: 98%

The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review

Pons

Salvador‐Carulla

Calcedo‐Barba

et al. 2020

Health Science Reports

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Background and aim Having decision making capacity is central to the exercise of autonomy in mental health care. The objective of this scoping review is to summarize the evidence on the capacity of people with schizophrenia or bipolar disorder to make decisions about their treatment in real life to support medical practice. Methods Systematic search of observational studies on the assessment of capacity of patients with schizophrenia, psychosis, or bipolar disorder to make healthcare and treatment‐related decisions, conducted in any clinical setting published up to January 31, 2020 was performed. Free text searches and medical subject headings in English were combined in PubMed, Scopus, CINAHL, and PsycInfo. Publications were selected as per inclusion and exclusion criteria. The Newcastle‐Ottawa Scale for observational studies was used to assess the quality of publications. Results Thirty publications were reviewed. According to the Newcastle‐Ottawa Scale criteria, the publications reviewed were good quality. Findings showed that more than 70% of schizophrenia and schizoaffective disorder outpatients understood treatment options at the point of making decisions about their illness and healthcare. Patients treated voluntarily had considerably better scores for decisional capacity than those treated involuntarily. The burden of psychiatric symptoms could compromise decisional capacity temporarily. Decision‐making capacity improved over time from admission to discharge from hospital, and with treatment among psychiatry inpatients. Schizophrenia and bipolar disorder patients could be as competent as nonpsychiatric individuals in making decisions about their treatments in everyday life. Conclusions This scoping review provides a body of evidence for healthcare professionals in need of assessing the capacity of schizophrenia and bipolar disorder patients for autonomously decide about their treatments. Decisional capacity judgements should consider variations in capacity over time and be based on the type of decision to be made, the severity of symptoms, and the specific phase of the mental disorder.

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Section: Resultsmentioning

confidence: 98%

The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review

Pons

Salvador‐Carulla

Calcedo‐Barba

et al. 2020

Health Science Reports

View full text Add to dashboard Cite

show abstract

“…However, the absence of empirical data about objective coercion limits the possibility to verify this hypothesis in the present study. In other studies by our group the presence of mania was associated with involuntary hospitalization and a poorer capacity to consent to treatment Mandarelli et al, 2017;Mandarelli et al, 2014). It would be interesting to investigate the presence of an association between perceived coercion and capacity to consent to treatment in clinical populations and how cognitive and psychiatric symptoms play a role in this picture.…”

Section: Discussionmentioning

confidence: 76%

The Admission Experience Survey Italian Version (I-AES): A factor analytic study on a sample of 156 acute psychiatric in-patients

Mandarelli

Parmigiani

Trobia

et al. 2019

International Journal of Law and Psychiatry

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“…The IMHA correctly identifies decision-making capacity rather than status of admission as the key issue here. This is important: Mandarelli et al demonstrated high levels of decision-making capacity in patients receiving non-consensual psychiatric treatment [ 57 ]. The IMHA affirms that supported patients may retain the capacity to make treatment decisions.…”

Section: Discussionmentioning

confidence: 99%

Concordance of the Indian Mental Healthcare Act 2017 with the World Health Organization’s Checklist on Mental Health Legislation

Duffy

Kelly

2017

Int J Ment Health Syst

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BackgroundIndia is revising its mental health legislation with the Indian Mental Healthcare Act 2017 (IMHA). When implemented, this legislation will apply to over 1.25 billion people. In 2005, the World Health Organization (WHO) published a Resource Book (WHO-RB) on mental health, human rights and legislation, including a checklist of 175 specific items to be addressed in mental health legislation or policy in individual countries. Even following the publication of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (2006), the WHO-RB remains the most comprehensive checklist for mental health legislation available, rooted in UN and WHO documents and providing the most systematic, detailed framework for human rights analysis of mental health legislation. We sought to determine the extent to which the IMHA will bring Indian legislation in line with the WHO-RB.MethodsThe IMHA and other relevant pieces of Indian legislation are compared to each of the items in the WHO-RB. We classify each item in a binary manner, as either concordant or not, and provide more nuanced detail in the text.ResultsThe IMHA addresses 96/175 (55.4%) of the WHO-RB standards examined. When other relevant Indian legislation is taken into account, 118/175 (68.0%) of the standards are addressed in Indian law. Important areas of low concordance include the rights of families and carers, competence and guardianship, non-protesting patients and involuntary community treatment. The important legal constructs of advance directives, supported decision-making and nominated representatives are articulated in the Indian legislation and explored in this paper.ConclusionsIn theory, the IMHA is a highly progressive piece of legislation, especially when compared to legislation in other jurisdictions subject to similar analysis. Along with the Indian Rights of Persons with Disabilities Act 2016, it will bring Indian law closely in line with the WHO-RB. Vague, opaque language is however, used in certain contentious areas; this may represent arrangement-focused rather than realisation-focused legislation, and lead to inadvertent limitation of certain rights. Finally, the WHO-RB checklist is an extremely useful tool for this kind of analysis; we recommend it is updated to reflect the CRPD and other relevant developments.

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Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study

Cited by 72 publications

References 34 publications

The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review

The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review

The Admission Experience Survey Italian Version (I-AES): A factor analytic study on a sample of 156 acute psychiatric in-patients

Concordance of the Indian Mental Healthcare Act 2017 with the World Health Organization’s Checklist on Mental Health Legislation

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