title: Mental capacity and psychiatric in-patients: implications for the new mental health law in England and Wales.
abstract: BACKGROUND
  In England and Wales mental health services need to take account of the Mental Capacity Act 2005 and the Mental Health Act 1983. The overlap between these two causes dilemmas for clinicians.
  
  
  OBJECTIVE
  To describe the frequency and characteristics of patients who fall into two potentially anomalous groups: those who are not detained but lack mental capacity; and those who are detained but have mental capacity.
  
  
  METHODS
  Cross-sectional study of 200 patients admitted to psychiatric wards. We assessed mental capacity using a semi-structured interview, the MacArthur Competence Assessment Tool for Treatment (MacCAT-T).
  
  
  RESULTS
  Of the in-patient sample, 24% were informal but lacked capacity: these patients felt more coerced and had greater levels of treatment refusal than informal participants with capacity. People detained under the Mental Health Act with capacity comprised a small group (6%) that was hard to characterise.
  
  
  CONCLUSIONS
  Our data suggest that psychiatrists in England and Wales need to take account of the Mental Capacity Act, and in particular best interests judgments and deprivation of liberty safeguards, more explicitly than is perhaps currently the case.
authors.affiliation: Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, London SE5 9RJ, UK. g.owen@iop.kcl.ac.uk
authors.forename: Gareth S
authors.initials: GS
authors.lastname: Owen
authors.forename: George
authors.initials: G
authors.lastname: Szmukler
authors.forename: Genevra
authors.initials: G
authors.lastname: Richardson
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
authors.forename: Peter
authors.initials: P
authors.lastname: Hayward
authors.forename: James
authors.initials: J
authors.lastname: Rucker
authors.forename: Duncan
authors.initials: D
authors.lastname: Harding
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
mesh_terms: D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D005610:Freedom; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence* / Q000523:psychology; D001523:Mental Disorders / Q000523:psychology*; D008605:Mental Health Services / Q000331:legislation & jurisprudence*; D010349:Patient Compliance / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000453:epidemiology; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data; D014852:Wales