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Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting

Published online by Cambridge University Press:  01 September 2022

K. Tong ,
C. Har ,
H. Kennedy  and
M. Davoren
K. Tong*
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
C. Har
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
H. Kennedy
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland Central Mental Hospital and Trinity College Dublin, Dundrum Centre For Forensic Excellence, Dublin, Ireland
M. Davoren
Affiliation:
National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland Central Mental Hospital and Trinity College Dublin, Dundrum Centre For Forensic Excellence, Dublin, Ireland
*
*Corresponding author.

Abstract

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Introduction

Impairment in decision-making capacity is a serious consequence of executive dysfunction secondary to serious mental disorders like schizophrenia. Functional mental capacity (FMC) refers to an individual’s ability to make and communicate legally competent decisions autonomously. Studies have shown that FMC is dependent on severity of psychosis and can improve with treatment.

Objectives

To ascertain the correlation between the scores on a structured judgement tool, namely the Dundrum Capacity Ladders (DCL) with level of acuity of treatment setting and length of stay in a secure forensic hospital.

Methods

Sixty-two patients were interviewed using the DCL across three domains – healthcare, welfare and finances. Correlation between DCL scores, length of hospital stay and level of acuity of treatment setting was assessed.

Results

As patients moved from higher to lower dependency wards, mean DCL score increased, indicating a higher level of capacity. Patients in high dependency wards were most impaired while those in the low dependency wards performed significantly better (rs=0.472, p<0.001). The longer the patients stayed in the hospital, up until five years, the higher the mean welfare domain score (rs=0.402, p=0.011) and mean DCL score (rs=0.376, p=0.018). Beyond five years of hospital stay, those who had lower DCL scores and did not improve had longer length of stay.

Conclusions

Patients’ FMC improve as they progress from high to low level of acuity of treatment setting. However, this is dependent on the length of hospital stay. FMC may be a measure of recovery in the forensic setting.

Disclosure

No significant relationships.

Keywords

mental illnessfunctional capacitydecision-making capacitylength of hospital stay
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S349 - S350
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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