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Assessments of mental capacity in psychiatric inpatients: a retrospective cohort study.

Brown PF, Tulloch AD, Mackenzie C, Owen GS, Szmukler G, Hotopf M - BMC Psychiatry (2013)

Bottom Line: There was a significant increase in the frequency of capacity assessments carried out over the study period of 0.3 percentage points per month (95% CI 0.26-0.36, p < 0.00001).Over the period of the introduction of the MCA there has been a significant increase in the number of mental capacity assessments carried out on psychiatric inpatients.Although mental health services are considering the issue of capacity more frequently, mental capacity assessments are inconsistently applied and do not make adequate use of MCA criteria.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. penelope.brown@kcl.ac.uk

ABSTRACT

Background: The Mental Capacity Act 2005 (MCA) was introduced in 2007 to protect vulnerable individuals who lack capacity to make decisions for themselves and to provide a legal framework for professionals to assess incapacity. The impact of the MCA on clinical practice is not known. This study aims to evaluate how frequently mental capacity is assessed in psychiatric inpatients, whether the criteria for determining capacity set out in the MCA are used in practice, and whether this has increased with the introduction of the MCA.

Method: A retrospective cohort study was carried out using a case register of South East London mental health service users. The Case Register Interactive Search (CRIS) system enabled searching and retrieval of anonymised information on patients admitted to the South London and Maudsley NHS Foundation Trust since 2006. The presence and outcomes of documented mental capacity assessments in psychiatric admissions between May 2006 and February 2010 were identified and demographic information on all admissions was retrieved.

Results: Capacity assessments were documented in 1,732/17,744 admissions (9.8%). There was a significant increase in the frequency of capacity assessments carried out over the study period of 0.3 percentage points per month (95% CI 0.26-0.36, p < 0.00001). In only 14.7% of capacity assessments were the MCA criteria for assessing capacity explicitly used.

Conclusions: Over the period of the introduction of the MCA there has been a significant increase in the number of mental capacity assessments carried out on psychiatric inpatients. Although mental health services are considering the issue of capacity more frequently, mental capacity assessments are inconsistently applied and do not make adequate use of MCA criteria.

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Time trend (per month) of the percentage of inpatients in whom capacity was assessed during their admission.
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Figure 1: Time trend (per month) of the percentage of inpatients in whom capacity was assessed during their admission.

Mentions: The frequency of capacity assessments was analysed by month from May 2006 to January 2010. In the first month, 5% of admissions had an assessment; in the final month (January 2010) it was over 17%. Time-series regression indicated a significant increase in the proportion of assessments carried out over the study period (see Figure 1) with no evidence of autocorrelation (Durbin-Watson statistic = 2.22); the regression coefficient was 0.294 (95% CI: 0.258 to 0.328, p < 0.0001), showing a gradual increase in the proportion of approximately 0.3 percentage points per month. There was no step-wise increase in the proportion of inpatients assessed for capacity immediately after the introduction of the MCA in November 2007 (regression coefficient 0.59, 95% CI: -1.21 to 2.39, p = 0.5), perhaps suggesting an anticipatory effect of the change in legislation.


Assessments of mental capacity in psychiatric inpatients: a retrospective cohort study.

Brown PF, Tulloch AD, Mackenzie C, Owen GS, Szmukler G, Hotopf M - BMC Psychiatry (2013)

Time trend (per month) of the percentage of inpatients in whom capacity was assessed during their admission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643852&req=5

Figure 1: Time trend (per month) of the percentage of inpatients in whom capacity was assessed during their admission.
Mentions: The frequency of capacity assessments was analysed by month from May 2006 to January 2010. In the first month, 5% of admissions had an assessment; in the final month (January 2010) it was over 17%. Time-series regression indicated a significant increase in the proportion of assessments carried out over the study period (see Figure 1) with no evidence of autocorrelation (Durbin-Watson statistic = 2.22); the regression coefficient was 0.294 (95% CI: 0.258 to 0.328, p < 0.0001), showing a gradual increase in the proportion of approximately 0.3 percentage points per month. There was no step-wise increase in the proportion of inpatients assessed for capacity immediately after the introduction of the MCA in November 2007 (regression coefficient 0.59, 95% CI: -1.21 to 2.39, p = 0.5), perhaps suggesting an anticipatory effect of the change in legislation.

Bottom Line: There was a significant increase in the frequency of capacity assessments carried out over the study period of 0.3 percentage points per month (95% CI 0.26-0.36, p < 0.00001).Over the period of the introduction of the MCA there has been a significant increase in the number of mental capacity assessments carried out on psychiatric inpatients.Although mental health services are considering the issue of capacity more frequently, mental capacity assessments are inconsistently applied and do not make adequate use of MCA criteria.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. penelope.brown@kcl.ac.uk

ABSTRACT

Background: The Mental Capacity Act 2005 (MCA) was introduced in 2007 to protect vulnerable individuals who lack capacity to make decisions for themselves and to provide a legal framework for professionals to assess incapacity. The impact of the MCA on clinical practice is not known. This study aims to evaluate how frequently mental capacity is assessed in psychiatric inpatients, whether the criteria for determining capacity set out in the MCA are used in practice, and whether this has increased with the introduction of the MCA.

Method: A retrospective cohort study was carried out using a case register of South East London mental health service users. The Case Register Interactive Search (CRIS) system enabled searching and retrieval of anonymised information on patients admitted to the South London and Maudsley NHS Foundation Trust since 2006. The presence and outcomes of documented mental capacity assessments in psychiatric admissions between May 2006 and February 2010 were identified and demographic information on all admissions was retrieved.

Results: Capacity assessments were documented in 1,732/17,744 admissions (9.8%). There was a significant increase in the frequency of capacity assessments carried out over the study period of 0.3 percentage points per month (95% CI 0.26-0.36, p < 0.00001). In only 14.7% of capacity assessments were the MCA criteria for assessing capacity explicitly used.

Conclusions: Over the period of the introduction of the MCA there has been a significant increase in the number of mental capacity assessments carried out on psychiatric inpatients. Although mental health services are considering the issue of capacity more frequently, mental capacity assessments are inconsistently applied and do not make adequate use of MCA criteria.

Show MeSH