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

Published online by Cambridge University Press:  02 January 2018

Schalk du Toit*
Affiliation:
National Health Service Grampian, Royal Cornhill Hospital, 26 Cornhill Road, Aberdeen AB25 2ZH, email: s_dutoit@doctors.org.uk
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Abstract

Type
The columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2008

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, ). Although the authors gave no explanation, the result could be because in-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 a survey (Reference Hill, Mather and JamesHill 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 two or less of the five points in testing decision-making capacity (Department of Health, 2005; Re C, 1994). 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.

References

Department of Health (2005) Mental Capacity Act 2005. Department of Health.Google Scholar
Hill, S. A., Mather, G. I. & James, A. J. (2006) Assessing decision-making capacity: a survey of psychiatrists' knowledge. Medicine Science and the Law, 46, 6668.CrossRefGoogle ScholarPubMed
Re C (Adult: Refusal of Medical Treatment) [1994] 1 AllER 819.Google Scholar
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