Reliability of mental capacity assessments in psychiatric in-patients
Open accessAbstract
BACKGROUND: Previous work on the reliability of mental capacity assessments in patients with psychiatric illness has been limited. AIMS: To describe the interrater reliability of two independent assessments of capacity to consent to treatment, as well as assessments made by a panel of clinicians based on the same interview. METHOD: Fifty-five patients were interviewed by two interviewers 1-7 days apart and a binary (yes/no) capacity judgement was made, guided by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Four senior clinicians used transcripts of the interviews to judge capacity. RESULTS: There was excellent agreement between the two interviewers for capacity judgements made at separate interviews (kappa=0.82). A high level of agreement was seen between senior clinicians for capacity judgements of the same interview (mean kappa=0.84). CONCLUSIONS: In combination with a clinical interview, the MacCAT-T can be used to produce highly reliable judgements of capacity.
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Capacity assessments for treatment decisions have strong test-retest reliability.
“As noted by Cairns et al., 2005 andRaymont et al., 2007, the latter also suggests strong test-retest reliability.”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Cairns et al., 2005
The Interrater agreements section reports near-perfect agreement (κ=0.82) for treatment-capacity judgments from separate interviews of the same patients. The paper’s limitations describe this measure as a hybrid of interrater and test–retest reliability, not a measure of pure test–retest reliability. In the citing sentence, “the latter” appears to assign the test–retest point to Raymont et al., rather than Cairns et al. (LLM, conf=0.86)
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- Authors
- Cairns, R., Maddock, C., Buchanan, A., David, A. S., Hayward, P., Richardson, G., Szmukler, G., & Hotopf, M.
- Affiliations
- Yale University (US)
- Maudsley Hospital (GB)
- University of London (GB)
- Corresponding author
- Hotopf, Matthew
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2005-10
- Volume
- 187
- Issue
- 4
- Pages
- 372-378
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2101603047
- Cited by
- 135
- References
- 23
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 6 · 2022: 2 · 2021: 5 · 2020: 4 · 2019: 5 · 2018: 9 · 2017: 5 · 2016: 6 · 2015: 5 · 2014: 6 · 2013: 7 · 2012: 7
- FWCI
- 9.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust
- 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, inter-rater reliability, consent to treatment, psychiatric inpatients, clinical interview, clinician agreement, capacity to consent
- MeSH terms
- Adult, Mental Disorders, Decision Making, Female, Hospitalization, Humans, Informed Consent, Interview, Psychological, Male, Patient Care Team, Psychiatric Status Rating Scales, Reproducibility of Results, Observer Variation, Mental Competency
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