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Mental capacity in psychiatric patients: Systematic review
Open accessAbstract
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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
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“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
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“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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Metadata
- 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
- 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
- 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
- bronze
- doi.org
- 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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