The impact of context on assessments of mental capacity by psychiatrists

Abstract

Background: The assessment of mental capacity in patients who have self harmed is often difficult. Contextual factors may influence judgements on mental capacity.

Aims: To determine the proportion of consultant psychiatrists who judge a self harming patient described in a vignette likely to have mental capacity, and to test the hypothesis that judgements are influenced by contextual factors which should not necessarily influence mental capacity.

Method: Four hundred and four consultant psychiatrists were randomized to receive one of four vignettes describing a woman who took a serious paracetamol overdose and required liver transplantation.

Results: Seventy percent of questionnaires were returned. Forty-nine percent of participants thought that the patient lacked mental capacity. There was no statistically significant effect of vignette on judgement of mental capacity (p = .4). Psychiatric speciality of the participants influenced capacity judgements (p = .06), with old age psychiatrists being least likely to judge her as lacking capacity (36%) and psychotherapists being most likely to do so (80%).

Conclusions: This study suggests that clinicians' assessments of capacity are not greatly influenced by context, but that psychiatric speciality has some impact.

Declaration of interest: None.

Keywords:

• Suicide
• mental capacity
• consent
• assessment
• decision making
• mental disorder
• treatment