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Reliability of mental capacity assessments in psychiatric in-patients

  • Ruth Cairns (a1), Clementine Maddock (a1), Alec Buchanan (a2), Anthony S. David (a1), Peter Hayward (a3), Genevra Richardson (a4), George Szmukler (a5) and Matthew Hotopf (a5)...
Abstract
Background

Previous work on the reliability of mental capacity assessments in patients with psychiatric illness has been limited.

Aims

To describe the interrater reliability of two independent assessments of capacity to consent to treatment, as well as assessments made by a panel of clinicians based on the same interview.

Method

Fifty-five patients were interviewed by two interviewers 1–7 days apart and a binary (yes/no) capacity judgement was made, guided by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Four senior clinicians used transcripts of the interviews to judge capacity.

Results

There was excellent agreement between the two interviewers for capacity judgements made at separate interviews (kappa=0.82). A high level of agreement was seen between senior clinicians for capacity judgements of the same interview (mean kappa=0.84)

Conclusions

In combination with a clinical interview, the MacCAT–T can be used to produce highly reliable judgements of capacity.

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Copyright
Corresponding author
Professor Matthew Hotopf, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. Tel: +44(0)2078480778; fax: +44(0)2078485408; e-mail: m.hotopf@iop.kcl.ac.uk
Footnotes
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See pp. 379–385, this issue.

Declaration of interest

None. The study was funded by the Wellcome Trust.

Footnotes
References
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Reliability of mental capacity assessments in psychiatric in-patients

  • Ruth Cairns (a1), Clementine Maddock (a1), Alec Buchanan (a2), Anthony S. David (a1), Peter Hayward (a3), Genevra Richardson (a4), George Szmukler (a5) and Matthew Hotopf (a5)...
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