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Mental capacity in practice part 2: capacity and the suicidal patient

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

This article is the second of two looking at assessment of mental capacity in clinical practice. In it, we explore capacity assessments in the context of suicidal thoughts and acts. The laws governing doctors’ responsibility to suicidal patients in England and Wales are poorly understood, with tensions at the interface between the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). Dynamics of the clinical encounter (including the countertransference) further exacerbate uncertainty about how clinicians should balance patients’ autonomy with protection of life. We use a case example of a patient presenting with suicidality to describe good practice, based on a balance of legal and clinical principles and up-to-date case law. We discuss the difficulty in applying the MCA in relation to patients who appear to lack a consistent and coherent sense of self and others and consider whether the MCA is fit for purpose in determining whether someone with a personality disorder diagnosis should be permitted to end their own life.

Keywords

Suicideconsent and capacitypsychiatry and lawself-harmeducation and training
Type
Article
Information
BJPsych Advances , Volume 30 , Issue 1 , January 2024 , pp. 11 - 20
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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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References

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