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Mental capacity in practice part 1: how do we really assess capacity?

Published online by Cambridge University Press:  28 February 2023

Chloe Beale Open the ORCID record for Chloe Beale [Opens in a new window] ,
James Lee-Davey Open the ORCID record for James Lee-Davey [Opens in a new window] ,
Tennyson Lee Open the ORCID record for Tennyson Lee [Opens in a new window]  and
Alex Ruck Keene
Chloe Beale*
Affiliation:
Consultant liaison psychiatrist with the Homerton Psychological Medicine team at Homerton University Hospital, London, trust lead for suicide prevention for East London NHS Foundation Trust and an honorary clinical senior lecturer at Queen Mary University of London, UK.
James Lee-Davey
Affiliation:
Consultant liaison psychiatrist in the Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, and an honorary clinical senior lecturer at Queen Mary University of London, UK.
Tennyson Lee
Affiliation:
Consultant psychiatrist in psychotherapy and a psychoanalyst. He is clinical lead in Deancross Personality Disorder Service, East London NHS Foundation Trust, and co-director of the Centre for Understanding of Personality Disorder (CUSP), linked to the Wolfson Institute of Preventive Medicine at Queen Mary University of London, UK.
Alex Ruck Keene
Affiliation:
Specialist mental capacity barrister at 39 Essex Chambers in London, UK. He is also a Wellcome Research Fellow (on the Mental Health and Justice Project) and Visiting Professor at King's College London, and a visiting senior lecturer at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
*
Correspondence Dr Chloe Beale. Email: chloebeale@nhs.net
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Summary

Significant problems exist in understanding and implementing the Mental Capacity Act 2005 (MCA) despite it having been in place in England and Wales for more than 15 years. Although many guidelines exist on the assessment of capacity, it is difficult to apply such guidance in practice, given the complexity of actual situations. We may know the stages of the test for capacity, but do we really understand what they mean and how to assess them? In this, the first of two articles examining the MCA and challenges in its application, we add to existing legal guidance to explore capacity assessment in detail using a clinical scenario, and use case law and case studies to illustrate the subtleties and difficulties that may arise.

Keywords

Consent and capacityMental Capacity Actethicspsychiatry and laweducation and training
Type
Article
Information
BJPsych Advances , Volume 30 , Issue 1 , January 2024 , pp. 2 - 10
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

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