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Cited by 263Healthcare Decision-Making and RestraintsEthics and bioethics in healthcareHealth, Medicine and Society

Mental capacity in psychiatric patients: Systematic review

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Okai, David, Owen, Gareth, McGuire, Hugh, Singh, Swaran, Churchill, Rachel, Hotopf, Matthew·2007·British Journal of Psychiatry
DOI 10.1192/bjp.bp.106.035162
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Abstract

BACKGROUND: Mental capacity is central to legal and ethical debates on the use of compulsion in psychiatry. AIMS: To describe the clinical epidemiology of mental incapacity in patients with psychiatric disorders, including interrater reliability of assessments, frequency in the psychiatric population and associations of mental incapacity. METHOD: Cross-sectional studies of capacity to consent to treatment for psychiatric patients were systematically reviewed from Medline, EMBASE and PsycInfo databases. Information on the reliability of assessments, frequency and associations of mental incapacity was extracted. RESULTS: Out of 37 papers reviewed, 29 different capacity assessment tools were identified. Studies were highly heterogeneous in their measurement and definitions of capacity. Interrater reliabilities between tools were high. Studies indicate incapacity is common (median 29%) but the majority of psychiatric in-patients are capable of making treatment decisions. Psychosis, severity of symptoms, involuntary admission and treatment refusal were the strongest risk factors for incapacity. CONCLUSIONS: Mental capacity can be reliably assessed. The majority of psychiatric in-patients have capacity, and socio-demographic variables do not have a major impact but clinical ones do.

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  • Okai et al. (2007) concluded that evaluation of capacity can be easily replicated.

    “In 2007, a review concluded that the majority of psychiatric patients have capacity, that clinical variables have an influence on the capacity for treatment decisions, and that its evaluation can be easily replicated (Okai et al., 2007).”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Okai et al., 2007

    The Discussion (page not provided) concludes that standardized capacity assessments have high interrater reliability, and the section on binary assessments says raters using a consistent approach can reach a high level of agreement. This supports reproducibility under those conditions, but the paper does not conclude that evaluation is easy to replicate; agreement is lower when formal assessments are compared with clinicians’ impressions. (LLM, conf=0.84)

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  • The remaining studies show high heterogeneity in the decision to be evaluated and in the rate of incapacity, which ranges from 10% to 87% in the samples.

    “The remaining studies show high heterogeneity in the decision to be evaluated, without specifying the treatment (Kahn et al., 2009;Okai et al., 2007;G. S. Owen et al., 2008G. S. Owen et al., , 2011) ) as well as in the rate of incapacity, which ranges from 10% to 87% in the samples.”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Okai et al., 2007

    The Results and Capacity assessments sections describe substantial variation in how studies assessed capacity and in the decisions assessed. However, the Psychiatric in-patients: other treatments section reports incapacity estimates ranging from 10% to 95%, not 10% to 87%. No page numbers are available in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Capacity assessments for treatment decisions have strong inter-rater reliability, whether professionals evaluate capacity jointly or on separate occasions.

    “As in (Okai et al., 2007), we found that capacity assessments for treatment decisions have strong inter-rater reliability, either when professionals evaluate this jointly or on separate occasions.”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Okai et al., 2007

    The section on reliability of binary assessments reports high agreement when raters use the same assessment approach, including a study with interviews conducted by separate interviewers. Most other studies had raters assess the same recorded or transcribed interview; the paper does not say they evaluated capacity jointly. It also reports lower agreement when structured assessments are compared with clinicians’ judgments. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Okai et al. (2007) concluded that the majority of psychiatric patients have capacity.

    “A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC, and its assessment is reliable.”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Okai et al., 2007

  • Okai et al. (2007) concluded that clinical variables influence capacity for treatment decisions.

    “In 2007, a review concluded that the majority of psychiatric patients have capacity, that clinical variables have an influence on the capacity for treatment decisions, and that its evaluation can be easily replicated (Okai et al., 2007).”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Okai et al., 2007

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Authors
Okai, D., Owen, G., McGuire, H., Singh, S., Churchill, R., & Hotopf, M.
Affiliations
  • South London and Maudsley NHS Foundation Trust (GB)
  • University of Warwick (GB)
  • King's College London (GB)
Corresponding author
Hotopf, Matthew
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2007-10
Volume
191
Issue
4
Pages
291-297
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.106.035162
OpenAlex
W2157242561
Cited by
262
References
57
Citations by year
2026: 3 · 2025: 13 · 2024: 7 · 2023: 7 · 2022: 10 · 2021: 21 · 2020: 27 · 2019: 18 · 2018: 10 · 2017: 18 · 2016: 16 · 2015: 12 · 2014: 15 · 2013: 16 · 2012: 10
FWCI
2.44
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 3746 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
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 › Health Professions › General Health Professions › Health, Medicine and Society
Keywords
decision-making capacity, psychiatric patients, capacity assessment, inter-rater reliability, treatment refusal, involuntary admission, psychosis, symptom severity, psychiatric inpatients, clinical epidemiology
MeSH terms
Mental Disorders, Cross-Sectional Studies, Decision Making, Hospitalization, Humans, Informed Consent, Interview, Psychological, Psychiatric Status Rating Scales, Severity of Illness Index, Reproducibility of Results, Databases, Bibliographic, Mental Competency, Persons with Psychiatric Disorders, Mentally Ill Persons

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