Concordance of mental capacity assessments based on legal and clinical criteria: A cross-sectional study of psychiatry inpatients
Abstract
This study aimed to compare assessments of mental capacity based on legal criteria with assessments based on clinical criteria among psychiatry inpatients to establish the concordance, if any, between these two approaches to assessing mental capacity. We assessed mental capacity for treatment decisions in 215 psychiatry inpatients (176 voluntary and 39 involuntary) in four psychiatry admission units in Ireland using both legal criteria (Ireland's Assisted Decision-Making (Capacity) Act 2015) and clinical criteria (the MacArthur Competence Assessment Tool for Treatment; MacCAT-T). Over one third of participants (34.9%) lacked mental capacity for treatment decisions according to the legal criteria. Mental incapacity was associated with involuntary admission status, being unemployed, a primary diagnosis of schizophrenia or a related disorder, and older age. Patients who lacked mental capacity according to the legislation scored significantly lower on all subscales of the MacCAT-T than patients who had mental capacity. We conclude that mental capacity assessments based on legal criteria correlate closely with those based on clinical criteria. These findings support current legal definitions of mental incapacity in Ireland and other jurisdictions with similar legislation (e.g. England and Wales).
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When the Irish legal criteria was used for this sample, 34.9% of inpatients were considered to lack capacity.
“On the other hand, when the Irish legal criteria was used for this sample, instead of questionnaires or scales, then this figure increased to 34.9% (95% CI [29 -42%]) of inpatients being considered to lack capacity (Curley, Murphy, Plunkett, et al., 2019c).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Curley, Murphy, Plunkett, et al., 2019c
Unemployment was associated with incapacity in three studies.
“Unemployment was associated with incapacity in three studies (Curley, Murphy, Plunkett, et al., 2019c;Di & Cheng, 2013;Skipworth et al., 2013).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Curley, Murphy, Plunkett, et al., 2019c
Schizophrenia was the psychiatric diagnosis associated with the highest rate of incapacity in six studies.
“Schizophrenia was the psychiatric diagnosis associated with the highest rate of incapacity in six studies (Curley, Murphy, Plunkett, et al., 2019c;Fraguas et al., 2007;Mandarelli et al., 2018b;G. Owen et al., 2009;G. S. Owen et al., 2011;Tor et al., 2020)”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Curley, Murphy, Plunkett, et al., 2019c
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References 20 · Cited by 16
- Authors
- Curley, A., Murphy, R., Plunkett, R., & Kelly, B. D.
- Affiliations
- Trinity College Dublin (IE)
- Beaumont Hospital (IE)
- Corresponding author
- Curley, Aoife
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 276
- Pages
- 160-166
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2944169087
- Cited by
- 16
- References
- 20
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2022: 1 · 2021: 2 · 2020: 5 · 2019: 2
- FWCI
- 2.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- mental capacity assessment, legal criteria, clinical criteria, Assisted Decision-Making (Capacity) Act 2015, involuntary admission, treatment decision-making, schizophrenia, concordance
- MeSH terms
- Mental Status and Dementia Tests, Adult, Aged, Cross-Sectional Studies, Decision Making, Female, Hospitalization, Humans, Inpatients, Ireland, Male, Middle Aged, Psychiatry, Schizophrenia, Reproducibility of Results, Mental Competency
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