Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study.
OBJECTIVE
To estimate the prevalence of mental capacity to make decisions on treatment in people from different diagnostic and legal groups admitted to psychiatric hospital.


METHODS
Cross sectional study.


METHODS
General adult acute psychiatric inpatient units.


METHODS
350 consecutive people admitted to psychiatric wards from the community over 16 months.


METHODS
Mental capacity assessed by clinical interview and the MacArthur competence assessment tool for treatment.


RESULTS
Estimates of mental capacity were obtained on 97% (n=338) of the 350 people admitted. Of those an estimated 60% (95% confidence interval 55% to 65%) lacked mental capacity to make decisions on treatment. This proportion varied according to diagnosis, ranging from 97% (n=36) in people with mania to 4% (n=24) in people with personality disorder. Mental incapacity was common in patients admitted informally to the psychiatric wards (n=188; 39%, 32% to 46%). Incapacity and detention are closely associated under non-capacity based mental health law.


CONCLUSIONS
Mental incapacity to make decisions on treatment is common in people admitted to psychiatric wards from the community but cannot be presumed. It is usual in those detained under the Mental Health Act and common in those admitted voluntarily.
Owen
Gareth S
GS
Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF.
Richardson
Genevra
G
David
Anthony S
AS
Szmukler
George
G
Hayward
Peter
P
Hotopf
Matthew
M
D000328:Adult; D003430:Cross-Sectional Studies; D003657:Decision Making; D004739:England; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D007258:Informed Consent; D008297:Male; D016743:Mental Competency; D001523:Mental Disorders / Q000523:psychology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D014852:Wales