Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-28T03:45:28.108Z Has data issue: false hasContentIssue false
  • English
  • Français

The early experience of Old Age Psychiatrists in the application of the Mental Capacity Act 2005: a pilot study

Published online by Cambridge University Press:  25 June 2009

Ajit Shah ,
Natalie Banner ,
Chris Heginbotham  and
Bill Fulford
Ajit Shah*
Affiliation:
Institute for Philosophy, Diversity and Mental Health, International School for Communities, Rights and Inclusion, University of Central Lancashire, Preston and West London Mental Health NHS Trust, London, U.K.
Natalie Banner
Affiliation:
Institute for Philosophy, Diversity and Mental Health, International School for Communities, Rights and Inclusion, University of Central Lancashire, Preston, U.K.
Chris Heginbotham
Affiliation:
Institute for Philosophy, Diversity and Mental Health, International School for Communities, Rights and Inclusion, University of Central Lancashire, Preston, U.K.
Bill Fulford
Affiliation:
Institute for Philosophy, Diversity and Mental Health, International School for Communities, Rights and Inclusion, University of Central Lancashire, Preston, U.K.
*
Correspondence should be addressed to: Professor Ajit Shah, West London Mental Health NHS Trust, Uxbridge Road, Southall, Middlesex UB1 3EU, U.K. Phone: +44 (0)208 354 8191; Fax: +44 (0)208 354 8307. Email: ajit.shah@wlmht.nhs.uk.
Get access

Abstract

Background: The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales.

Methods: A pilot questionnaire study examined the experience of consultants in Old Age Psychiatry in the early implementation of the MCA pertaining to local policy and training in the application of the MCA, the assessment of decision-making capacity, the determination of best interests, and the use of the least restrictive option and restraint.

Results: Fifty-two (27%) of the 196 consultants in Old Age Psychiatry returned useable questionnaires. Seventy-five percent of them reported that local training on the application of the MCA was available, but less than 50% reported that training was mandatory. The vast majority of assessments of decision-making capacity were conducted by consultants in Old Age Psychiatry. Almost all of them reported using the four-fold specific test of decision-making capacity (DMC) described in the MCA. Restraint was reported to be rarely used.

Conclusions: Consultants in Old Age Psychiatry generally reported using the criteria for the assessment of DMC, the determination of best interests and restraint described in the MCA. The findings highlight concern about the workload of clinicians in implementing the MCA and this requires careful monitoring. Consideration should be given to statutory provision of training in the application of the MCA by all healthcare and social care providers for all their healthcare and social care staff.

Keywords

Mental Capacity Actcapacity to make decisionspsychiatry
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 147 - 157
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appelbaum, P. S. and Grisso, T. (1995). The MacArthur treatment competence study. I: mental illness and competence to consent to treatment. Law and Human Behaviour, 19, 105–126.CrossRefGoogle Scholar
Banner, N. and Shah, A. K. (2007). An overview of the Mental Capacity Act (2005) for England and Wales. Bulletin IPA, 24 (3), 12, 19.Google Scholar
Barton, C. D., Mallik, H. S., Orr, W. B. and Janofsky, J. S. (1996). Clinicians' judgement of capacity of nursing home patients to give informed consent. Psychiatric Services, 47, 956–960.Google ScholarPubMed
Cairns, R. et al. (2005). Prevalence and predictors of mental incapacity in psychiatric inpatients. British Journal of Psychiatry, 187, 379–385.CrossRefGoogle Scholar
Cowan, J. (2007). Are we prepared for the Mental Capacity Act? Clinical Governance, 12, 64–70.CrossRefGoogle Scholar
Department of Constitutional Affairs (2005). The Mental Capacity Act 2005. www.opsi.gov.uk/acts/acts2005/20050009.htm.Google Scholar
Department of Constitutional Affairs (2007). Mental Capacity Act Code of Practice (2007 final edition). Code of Practice to the Mental Capacity Act 2005. www.dca.gov.uk/legal-policy/mental-capacity/mca-cp.pdf.Google Scholar
Department of Health (2005). New Ways of Working for Psychiatrists: Enhancing Effective, Person-Centred Services Through New Ways of Working in Multidisciplinary and Multiagency Contexts. Final Report “But Not the End of Story”. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4122342.Google Scholar
Evans, L. K., Strumpf, N. E, Allen-Taylor, S. L., Capezuti, E., Maislin, G. and Jacobsen, B. (1997). A clinical trial to reduce restraint in nursing homes. Journal of the American Geriatrics Society, 45, 675–681.CrossRefGoogle ScholarPubMed
Grisso, T. and Appelbaum, P. S. (1995). The MacArthur treatment competence study. III: abilities of patients to consent to psychiatric and medical treatment. Law and Human Behaviour, 19, 149–174.CrossRefGoogle Scholar
Grisso, T., Appelbaum, P. S., Mulvey, E. P. and Fletcher, K. (1995). The MacArthur treatment competence study. II: measures of abilities related to competence to consent to treatment. Law and Human Behaviour, 19, 127–148.CrossRefGoogle ScholarPubMed
Grisso, T., Appelbaum, P. S. and Hill-Fotouchi, C. (1997). The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions. Psychiatric Services, 48, 1415–1419.Google ScholarPubMed
Gurian, B. S., Baker, E. H., Jacobson, S., Lagerbom, B. and Watts, P. (1990). Informed consent for neuroleptics with elderly patients in two settings. Journal of the American Geriatrics Society, 38, 37–44.CrossRefGoogle ScholarPubMed
Jeste, D.V and Saks, E. (2006). Decisional capacity in mental illness and substance use of disorders: empirical database and policy implications. Behavioural Science and Law, 24, 607–628.CrossRefGoogle ScholarPubMed
Jones, R. (2005). Review of Mental Capacity Act 2005. Psychiatric Bulletin, 29, 423–427.CrossRefGoogle Scholar
Khan, K., Bhatkal, S. and Shah, A. K. (2007). Bournewood proposals: practical considerations. Geriatric Medicine, 37, 37–38.Google Scholar
McCullock, J. (2009). (In)capacity legislation in practice. Psychiatric Bulletin, 33, 20–22.CrossRefGoogle Scholar
Migon, M. N., Coutinho, E. S., Huf, G., Adams, C. E., Cunha, G. M and Allen, M. H. (2008). Factors associated with the use of physical restraints for agitated patients in psychiatric emergency rooms. General Hospital Psychiatry, 30, 263–268.CrossRefGoogle ScholarPubMed
Ministry of Justice (2007). Mental Capacity Act 2005: Equality Impact Assessment. www.justice.gov.uk/docs/mc-equality-impact.pdf.Google Scholar
Mukherjee, S. and Shah, A. K. (2001). The prevalence and correlates of capacity to consent to a geriatric psychiatry admission. Ageing and Mental Health, 5, 335–339.CrossRefGoogle ScholarPubMed
Myron, R., Gillespie, S., Swift, T. and Williamson, I. (2008). Whose decision? An Exploration of the Preparation for and Implementation of the Mental Capacity Act in Statutory and Non Statutory Services in England and Wales. Available at: www.mentalhealth.org.uk/our-work/research/all-age-groups/whose-decision/ (last asccessed 8 May 2008).Google Scholar
Odawara, T., Narita, H., Yamada, Y., Fujita, J., Yamada, T. and Hirayasu, Y. (2005). Use of restraint in a general hospital psychiatric unit in Japan. Psychiatry and Clinical Neuroscience, 59, 605–609.CrossRefGoogle Scholar
Okai, D., Owen, G., McGuire, H., Singh, S., Churchill, R. and Hotopf, M. (2007). Mental capacity in psychiatric patients. Systematic Review. British Journal of Psychiatry, 191, 291–297.CrossRefGoogle ScholarPubMed
Owen, G. S., Richardson, G., David, A. S., Szmukler, G., Hayward, P. and Hotopf, M. (2008). Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross-sectional study. BMJ, 337, a448. doi:10.1136/bmj.39580.546597.BE.CrossRefGoogle ScholarPubMed
Raymont, V. et al. (2004). Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study. Lancet, 364, 1421–1427.CrossRefGoogle ScholarPubMed
Rendina, N., Brodaty, H., Draper, B., Peisah, C. and Brugue, E. (2009). Substitute consent for nursing home residents prescribed psychotropic medication. International Journal of Geriatric Psychiatry, 24, 226–231.CrossRefGoogle ScholarPubMed
Shah, A. K. and Dickenson, D. (1999). The capacity to make decisions in dementia: some contempory issues. International Journal of Geriatric Psychiatry, 14, 803–806.3.0.CO;2-Z>CrossRefGoogle Scholar
Shah, A. K. and Mukherjee, S. (2003). Ascertaining capacity to consent: a survey of approaches used by psychiatrists. Medicine, Science and the Law, 43, 231–235.CrossRefGoogle ScholarPubMed
Shah, A. K. et al. (2008). A pilot study of the early impact of the Mental Capacity Act 2005: a questionnaire study of consultant psychiatrists. Unpublished report available from the author.Google Scholar
Shah, A. K., Heginbotham, C., Fulford, B. and Banner, N. (2009a). The application of the Mental Capacity Act 2005 among geriatric psychiatry patients: a pilot study. International Psychogeriatrics. E-published ahead of print, doi:10:1017/S1041610209990391.CrossRefGoogle Scholar
Shah, A. K, Heginbotham, C. and Kinton, M. (2009b). Deprivation of liberty safeguards in England and Wales. Geriatric Medicine, 39, 216–218.Google Scholar
Shah, A. K., Heginbotham, C. and Kinton, M. (2009c). The legal authority to “more than merely restrain” incapacitated patients: the interface between the Mental Capacity Act and the revised Mental Health Act in England and Wales. Mental Health Review, 14 (online).CrossRefGoogle Scholar
Shickle, D. (2006). The Mental Capacity Act 2005. Clinical Medicine, 6, 169–173.CrossRefGoogle ScholarPubMed
Stanley, N. et al. (2007a). Mental Capacity Act 2005. Core Training Set. Department of Health.Google Scholar
Stanley, N. et al. (2007b). Mental Capacity Act 2005. Community Care and Primary Care Training Set. Department of Health.Google Scholar
Stanley, N. et al. (2007c). Mental Capacity Act 2005. Acute Hospital Training Set. Department of Health.Google Scholar
Stanley, N. et al. (2007d). Mental Capacity Act 2005. Residential Accommodation Training Set. Department of Health.Google Scholar
Stanley, N. et al. (2007e). Mental Capacity Act 2005. Mental Health Training Set. Department of Health.Google Scholar
White, S. M. and Baldwin, T. J. (2006). The Mental Capacity Act 2005 – implications for anaesthesia and critical care. Anaesthesia, 61, 381–389.CrossRefGoogle ScholarPubMed