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Fundamentals of mental health assessment for non–mental health practitioners
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Mental capacity means having a state of mind that is sound to make your own decisions, although, being able to make decision can often be problematic for anyone, with many day-to-day circumstances hindering decision-making, including tiredness, indecisiveness, environmental factors, physical and emotional factors and in particular mental illness. The purpose of the Mental Capacity Act [MCA] (Great Britain 2005) is to safeguard and empower vulnerable individuals over the age of 16 who may be unable to make decisions on their own due to their capacity being hindered by disability or illness. However, deciding that someone lacks capacity must not be established by his or her age, appearance, condition or behaviour alone (Great Britain 2005).
Management of communication and swallowing at the end of life
Published in Rebecca Allwood, Working with Communication and Swallowing Difficulties in Older Adults, 2022
It is important to talk to the person about the fact that they are dying. It has been found that conversations with elderly people about their imminent death occur less frequently than with younger people (Lindskog et al., 2015). Unless people have previously specifically stated that they do not want to know, it is good practice to initiate these conversations to help support the person emotionally and to help meet any needs or requests for their final stage of life. Having the conversation about death paves the way for the person to be involved in decision making about their own death and to have some sense of control about how they would like that to be; for example, preference to die at home or the hospital, or choices regarding medication. Some of these decisions may have been made previously in formal advanced care plans (see Chapter 8), but these can be revisited or adapted if the person has retained mental capacity and appears to have changed their opinion. Otherwise, family members with legal power to make medical decisions, if the person has lost mental capacity, can be consulted to help with decision making.
Consent to treatment
Published in Gary Chan Kok Yew, Health Law and Medical Ethics in Singapore, 2020
The clinical assessment of mental capacity depends on the person’s state of mind and possible external factors impacting on the diagnosed mental disorders.35 Reference may be made to expert evidence and symptoms enumerated in diagnostic manuals.36 Doctors may also use certain questionnaires and tests37 to assess mental capacity.
Stretching beyond our perceived boundaries: The role of speech-language pathology in realising autonomy through supported decision-making
Published in International Journal of Speech-Language Pathology, 2023
Autonomy is enshrined in the Convention on the Rights of Persons with Disabilities (CRPD; United Nations, 2006), the first international legal mechanism that specifically focused on the needs of people with disability. It came into force in 2008. Article 12(2) CRPD requires that, “State Parties shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” (UNCRPD, 2006). Through General Comment No. 1, the Committee on the Rights of Persons with Disabilities (CRPD Committee) distinguishes between “legal capacity” and “mental capacity”. According to the CRPD, the right to legal capacity is universal and means that everyone’s will and preferences must be given effect and respected within the context of the law, on an equal basis with others. Often referred to as the right to legal personhood, the right to legal capacity means that everyone has a right to be seen as a person before the law. Where someone is denied legal capacity, they are no longer a legal person. Importantly, this means they are not entitled to the same rights and responsibilities as other citizens, including a legal right to live an autonomous life. Often confused with legal capacity, mental capacity refers to a person’s decision-making ability, which may vary within and between individuals. The committee emphasises that difficulties with decision-making (mental capacity) should not be used to justify the denial of legal capacity or legal personhood (Arstein-Kerslake & Flynn, 2016).
“Harmful” Choices and Subjectivity: Against an Externalist Approach to Capacity Assessments
Published in The American Journal of Bioethics, 2022
Harleen Kaur Johal, Aoife M. Finnerty, Jordan A. Parsons
In England and Wales, the Mental Capacity Act 2005 provides a legal framework for making decisions for adults who lack capacity to make decisions for themselves. This framework starts from a presumption that a person has capacity (section 1(2)), thereafter requiring proof of incapacity through a two-stage test. First, section 2(1) requires that the person be unable to make the relevant decision because of an impairment or disturbance in the functioning of the mind or brain (i.e., the “diagnostic” test). Second, per section 3(1), the person must be unable to understand, retain, or use relevant information to reach a decision, or communicate that decision (i.e., the “functional” test). This emphasis on the person’s cognition—their internal abilities to understand and deliberate—in the determination of capacity is what Pickering and colleagues refer to as “internalism” (Pickering, Newton-Howes, and Young 2022). However, they argue that consideration of external factors, such as the “harmful consequences of a decision”, has a role in determining whether a person has capacity to make that decision. They suggest that “externalism” better reflects the realities of decision making and (what they describe as) competence judgements.1 In this commentary, we suggest that introducing measurements of harm into capacity assessments is indeterminate and inappropriate, as it may lead to paternalistic decision making and overprotection. We also consider the potential harm that may arise from practical applications of Pickering and colleagues’ proposed externalist approach, at both an individual and societal level.
Capacity to consent to treatment in psychiatry inpatients – a systematic review
Published in International Journal of Psychiatry in Clinical Practice, 2022
Aoife Curley, Carol Watson, Brendan D. Kelly
Some studies found an association between mental capacity and diagnosis, but others found no such relationship (Billick et al. 1996; Melamed et al., 1997; Howe et al. 2005; Aydin Er and Sehiralti 2014). Cairns and colleagues reported an association between mental incapacity and a diagnosis of mania and psychosis (Cairns et al. 2005a); Curley and colleagues found a link between mental capacity and a diagnosis other than schizophrenia or related disorder (Curley, Murphy, Fleming et al. 2019; Curley et al. 2019b); Grisso and Applebaum reported more significant deficits in understanding, reasoning and appreciation of illness in patients with schizophrenia, compared to those with major depression (Grisso and Appelbaum 1995a); Mandarelli and colleagues reported that patients with bipolar disorder generally scored higher on the MacCAT-T (i.e., greater capacity) than those with schizophrenia spectrum disorder (Mandarelli et al. 2018); and Owen and colleagues reported that manic episodes of bipolar and psychotic disorders were most strongly associated with incapacity (Owen, David et al. 2009). Two other studies did not assess differences in terms of diagnosis due to small numbers in subgroups (Hoffman and Srinivasan 1992; Tor et al. 2020). Overall, there is evidence of a link between lack of capacity and serious mental illness such as schizophrenia and bipolar disorder.