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Capacity in vacuo: An audit of decision-making capacity assessments in a liaison psychiatry service

  • Benjamin W. J. Spencer (a1) (a2), Gareth Wilson (a3), Ewa Okon-Rocha (a1) (a2), Gareth S. Owen (a1) (a2) and Charlotte Wilson Jones (a1) (a2)...
Abstract
Aims and method

We aimed to audit the documentation of decision-making capacity (DMC) assessments by our liaison psychiatry service against the legal criteria set out in the Mental Capacity Act 2005. We audited 3 months split over a 2-year period occurring before, during and after an educational intervention to staff.

Results

There were 21 assessments of DMC in month 1 (6.9% of all referrals), 27 (9.7%) in month 16, and 24 (6.6%) in month 21. Only during the intervention (month 16) did any meet our gold-standard (n = 2). Severity of consequences of the decision (odds ratio (OR) 24.4) and not agreeing to the intervention (OR = 21.8) were highly likely to result in lacking DMC.

Clinical implications

Our audit demonstrated that DMC assessments were infrequent and poorly documented, with no effect of our legally focused educational intervention demonstrated. Our findings of factors associated with the outcome of the assessment of DMC confirm the anecdotal beliefs in this area. Clinicians and service leads need to carefully consider how to make the legal model of DMC more meaningful to clinicians when striving to improve documentation of DMC assessments.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Benjamin Spencer (benjamin.spencer@kcl.ac.uk)
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Declaration of interest

None.

Footnotes
References
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1 Ranjith, G, Hotopf, M. ‘Refusing treatment – please see’: an analysis of capacity assessments carried out by a liaison psychiatry service. JRSM 2004; 97: 480–2.
2 Grisso, T, Appelbaum, PS. Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals: pp. xi, 211. Oxford University Press, 1998.
3 Care Quality Commission. Monitoring the Mental Health Act in 2011/12. CQC, 2013.
4 Department for Constitutional Affairs. Mental Capacity Act 2005: Code of Practice. TSO (The Stationery Office), 2007.
5 Select Committee on the Mental Capacity Act, Hardie ARH. The Mental Capacity Act 2005 Post-Legislative Scrutiny Report of 2013–14. TSO (The Stationery Office), 2014.
6 Raymont, V, Bingley, W, Buchanan, A, David, AS, Hayward, P, Wessely, S, et al. Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study. Lancet 2004; 364: 1421–7.
7 Owen, GS, Richardson, G, David, AS, Szmukler, G, Hayward, P, Hotopf, M. Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study. BMJ 2008; 337: a448.
8 Glezer, A, Stern, TA, Mort, EA, Atamian, S, Abrams, JL, Brendel, RW. Documentation of decision-making capacity, informed consent, and health care proxies: a study of surrogate consent. Psychosomatics 2011; 52: 521–9.
9 Church, M, Watts, S. Assessment of mental capacity: a flow chart guide. Psychiatr Bull 2007; 31: 304–7.
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11 Owen, GS, Szmukler, G, Richardson, G, David, AS, Hayward, P, Rucker, J, et al. Mental capacity and psychiatric inpatients: implications for the new mental health law in England and Wales. Br J Psychiatry 2009; 195: 257–63.
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Capacity in vacuo: An audit of decision-making capacity assessments in a liaison psychiatry service

  • Benjamin W. J. Spencer (a1) (a2), Gareth Wilson (a3), Ewa Okon-Rocha (a1) (a2), Gareth S. Owen (a1) (a2) and Charlotte Wilson Jones (a1) (a2)...
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