Mental Capacity

The right of the individual to make their own decisions on issues of finance and personal welfare is fundamental to service user care. Decision-making capacity may be adversely affected by the presence of mental disorder or impairment and it may therefore be necessary for somebody else to intervene and make decisions for the service user based on what is in their best interests. This has been confirmed through case law in England and Wales (Re F (Mental Patient: Sterilisation); Re T (Adult: Refusal of Medical Treatment)) and now through legislation with the implementation of the Mental Capacity Act 2005. The Act provides guidance on assessment of capacity (Mental Capacity Act 2005, section 3) as well as on how to determine whether an intervention would be in the individual’s best interests (Mental Capacity Act 2005, section 4). A significant part of this guidance includes the implementation of mechanisms such as Advance Refusals of Treatment and Lasting Powers of Attorney, which allow the individual to plan in advance for a time when capacity is lost. However, the practical impact of the Mental Capacity Act is an area which to date is extremely under-researched, particularly in the context of service users with bipolar disorder.

To this end, the PARADES project on Advance Directive Evaluation aims to investigate how service users with bipolar disorder use the Mental Capacity Act 2005 to plan in advance for the intense phases of their condition.

Main research questions

• To determine whether service users with bipolar disorder are making use of the Mental Capacity Act 2005 (MCA), particularly in relation to advance planning mechanisms.
• To determine the extent to which healthcare professionals are engaged with the MCA, particularly in relation to advance planning mechanisms.

The project consisted of three parts:

• A quantitative survey of psychiatrists (both general adult and old age) and service users. This would be conducted over a period of two years and was intended to track changing attitudes and trends over that time.
• A qualitative semi-structured interview of service users and psychiatrists, designed to investigate respondents’ direct experiences of the MCA 2005.
• Doctrinal legal analysis of Court of Protection case law and other areas of law which were relevant to the project, such as Trusts law.