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Original papers: Ankush Singhal, Alok Kumar, Ravindra B. Belgamwar, and Richard E. Hodgson Assessment of mental capacity: who can do it? Psychiatr Bull 2008; 32: 17-20 [Abstract] [Full text] [PDF]

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Assessment of mental capacity: who can do it, or who should do it?

Schalk W. du Toit, Tel: 01224 557602, Fax: 01224 557433   (19 February 2008)

Assessment of mental capacity: who can do it, or who should do it? 19 February 2008
Schalk W. du Toit, Specialty Registrar ST4 General Adult Psychiatry NHS Grampian, Royal Cornhill Hospital, 26 Cornhill Road, Aberdeen, AB15 6YP, Tel: 01224 557602, Fax: 01224 557433 Send letter to journal: Re: Assessment of mental capacity: who can do it, or who should do it? s_dutoit{at}doctors.org.uk Schalk W. du Toit, et al.	I was interested to read about the discrepancy in the number of capacity assessments, carried out by doctors on general adult and old age psychiatry wards. (Singhal et al, Psychiatric Bulletin, January 2008, 32, 17-19) Although the authors gave no explanation, the result could be because patients on the general adult wards, who probably lacked capacity, were more likely to be detained under the Mental Health Act and therefore fell outside the Bournewood gap. This result does however support my belief that doctors on general adult psychiatry wards do not assess their patient’s capacity (to consent to treatment) often enough. I took part in conducting a survey (Hill et al, 2006) in which consultant and trainee psychiatrists were asked, “What are the key elements in the assessment of a patient’s capacity?” Over a third of the 95 participants could only identify 2 or less of the 5 points in testing decision-making capacity. (England & Wales Mental Capacity Act 2005 and Re C test) This suggested an inadequate level of knowledge, and I believe that as doctors we could become even more de-skilled, should we rely entirely on our nursing colleagues to fulfil this role in future. The authors make the point that, “Appropriately trained mental health nursing staff can undertake this assessment.” I am sure they can, but should they? I believe it is appropriate that as prescribing doctors, we should be assessing our patient’s capacity to consent to the proposed treatment, and not merely delegate these duties to other healthcare professionals. This makes sense from an ethical and medico-legal perspective. Hill SA, Mather GI, James AJ. Assessing decision-making capacity: a survey of psychiatrists' knowledge. Medicine Science and the Law. Jan 2006; 46 (1): 66-8 Declaration of interest: None