Mental capacity in psychiatric patients: Systematic review.
BACKGROUND
Mental capacity is central to legal and ethical debates on the use of compulsion in psychiatry.


OBJECTIVE
To describe the clinical epidemiology of mental incapacity in patients with psychiatric disorders, including interrater reliability of assessments, frequency in the psychiatric population and associations of mental incapacity.


METHODS
Cross-sectional studies of capacity to consent to treatment for psychiatric patients were systematically reviewed from Medline, EMBASE and PsycInfo databases. Information on the reliability of assessments, frequency and associations of mental incapacity was extracted.


RESULTS
Out of 37 papers reviewed, 29 different capacity assessment tools were identified. Studies were highly heterogeneous in their measurement and definitions of capacity. Interrater reliabilities between tools were high. Studies indicate incapacity is common (median 29%) but the majority of psychiatric in-patients are capable of making treatment decisions. Psychosis, severity of symptoms, involuntary admission and treatment refusal were the strongest risk factors for incapacity.


CONCLUSIONS
Mental capacity can be reliably assessed. The majority of psychiatric in-patients have capacity, and socio-demographic variables do not have a major impact but clinical ones do.
Okai
David
D
Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
Owen
Gareth
G
McGuire
Hugh
H
Singh
Swaran
S
Churchill
Rachel
R
Hotopf
Matthew
M
D003430:Cross-Sectional Studies; D016206:Databases, Bibliographic; D003657:Decision Making; D006760:Hospitalization; D006801:Humans; D007258:Informed Consent; D007406:Interview, Psychological; D016743:Mental Competency; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D028642:Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012720:Severity of Illness Index