Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-22T19:36:56.916Z Has data issue: false hasContentIssue false
  • English
  • Français

The application of the Mental Capacity Act 2005 among geriatric psychiatry patients: 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: [email protected].
Get access

Abstract

Background: The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales. The experience of clinicians working in Old Age Psychiatry, who are likely to have greater experience in the use of MCA, in the early implementation of the MCA was examined.

Methods: Case-notes of 37 patients in seven different Old Age Psychiatry services in two mental health trusts in west London, who had received at least one assessment of decision-making capacity (DMC) for a specific issue, were examined. A qualitative thematic analysis pertaining to the criteria used for the assessment of DMC, determination of best interests, least restrictive option and unwise decision was used for data analysis.

Results: The main findings were: the criteria used for the assessment of DMC and the determination of best interests were those described in the MCA and the accompanying Code of Practice; and clinicians were developing the concepts of least restrictive option and unwise decision with face validity despite the absence of their definitions in the MCA.

Conclusion: Caution should be exercised in extrapolating the findings of this study, which is confined to two Mental Health Trusts in one geographical area and the speciality of Old Age Psychiatry, to other localities and other specialties. Nevertheless, there was evidence that clinicians were following the basic principles of the MCA correctly.

Keywords

Mental Capacity Actcapacityconsentbest interest
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 5 , October 2009 , pp. 922 - 930
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

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
Bhatkal, S. and Shah, A. K. (2004). Clinical and demographic characteristics of elderly Poles referred to a psychogeriatric service. International Psychogeriatrics, 16, 351–360.CrossRefGoogle Scholar
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_4122342Google Scholar
Haider, I. and Shah, A. K. (2004). A pilot study of behavioural and psychological signs and symptoms of dementia in patients of Indian sub-continent origin admitted to a dementia day hospital in the United Kingdom. International Journal of Geriatric Psychiatry, 19, 1195–1204.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
Markson, E. W. (2003). Social Gerontology Today. An Introduction. Los Angeles: Roxbury Publishing.Google Scholar
Marson, D. C., McInturff, B., Hawkins, L., Bartolucci, A. and Harrell, L. E. (1997a). Consistency of physician judgements of capacity to consent in mild Alzheimer's disease. Journal of the American Geriatrics Society, 45, 453–457.CrossRefGoogle ScholarPubMed
Marson, D. C., Hawkins, L., McInturff, B. and Harrell, L. E. (1997b).Cognitive models that predict physician judgements of capacity to consent in mild Alzheimer's disease. Journal of the American Geriatrics Society, 45, 458–464.CrossRefGoogle ScholarPubMed
McCullock, J. (2009). (In)capacity legislation in practice. Psychiatric Bulletin, 33, 20–22.CrossRefGoogle Scholar
Ministry of Justice (2007). Mental Capacity Act 2005. Equality Impact Assessment. www.justice.gov.uk/docs/mc-equality-impact.pdfGoogle 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 accessed 8 May 2008).Google Scholar
Odutoye, K. and Shah, A. K. (1999). The clinical and demographic characteristics of ethnic elders from the Indian sub-continent newly referred to a psychogeriatric service. International Journal of Geriatric Psychiatry, 14, 446–453.3.0.CO;2-L>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
Redelinghuys, J. and Shah, A. K. (1997). The characteristics of ethnic elders of Indian sub-continent origin in a west London psychogeriatric service. Ageing and Mental Health, 1, 243–247.CrossRefGoogle Scholar
Shah, A. K. (1996). The effect of the Community Care Act 1990 on discharge from a psychogeriatric unit to residential and nursing homes. Medicine, Science and the Law, 36, 327–330.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 Heginbotham, C. (2008). The Mental Capacity Act 2005: some implications for black and minority ethnic elders. Age & Ageing, 37, 242–243.CrossRefGoogle Scholar
Shah, A.K and MacKenzie, S. (2007). Disorders of ageing across cultures. In Bhugra, D. and Bhui, K. (eds.), Textbook of Cultural Psychiatry (pp. 323–344). Cambridge University Press, Cambridge.CrossRefGoogle Scholar
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. and Kinton, M. (2009a). Deprivation of liberty safeguards in England and Wales. Geriatric Medicine, 39, 216–218. Google Scholar
Shah, A. K., Heginbotham, C. and Kinton, M. (2009b). 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