Tom Palmer MD(Res) Scholarship 2018:    Title: Contested Capacity Assessments

Supervisors: Dr Gareth Owen, Alex Ruck Keene, Dr Scott Kim

Summary:  Patient decision-making is a critical issue in provision of mental health treatments. Assessment of decision-making capacity is increasingly central to mental health policy and practice, and many mental health problems have been linked with temporary loss of decision-making capacity for treatment or other decisions. Consider a young woman with anorexia whose weight is dangerously low but who refuses tube feeding - does she have the right to make her autonomous (if unwise) decision, or should the decision be made by others, bound by law to act in her best interests? There are many cases where assessment of capacity is hard or contested. I am particularly interested in how an assessor interacts with the assessed person’s individual values and beliefs relating to the decision at hand. This project takes a qualitative approach in order to clarify the clinical and legal factors that make some capacity cases difficult. I will interview liaison psychiatrists and legal professionals, and carry out focus groups with social workers, to explore the views and experiences of practitioners on their most difficult capacity assessments. I will use these findings, along with information from my team’s review of capacity cases at the Court of Protection, to categorise difficult cases in a way that will usefully contribute to the policy debates on mental health law reform in the UK and beyond. With service user input from the McPin Foundation, I will then design and test educational material aimed at helping practitioners to approach hard capacity assessments.

Research Student: Nuala Kane

 I am a medical graduate of NUI Galway in Ireland and a psychiatry trainee on the Maudsley Training Programme with clinical interests in liaison and older adult psychiatry. I am currently working as a clinical research associate on King’s College London’s Mental Health and Justice project on Contested Capacity Assessments.

 I have a longstanding interest in ethical concerns in mental health care and mental health policy. Before I started psychiatry training, I completed an MSc in Philosophy of Mental Disorder at King’s College London, writing my dissertation on advance directives for patients with bipolar disorder. I adapted this dissertation as an article published in the Journal of Evaluation in Clinical Practice, focusing specifically on the role of capacity assessments in this area. During my clinical training, I also completed two clinical audits relating to the Mental Capacity Act in practice and policy. I have a strong interest in medical education, and have experience as a teacher on Extreme Psychiatry, a unique psychiatry and anti-stigma course for third year medical students using simulation methods.

 My research focuses on difficult or contested capacity assessments, and involves exploring the role of the assessed person’s beliefs and values in these capacity assessments. I am lucky to have a supervisory team with expertise spanning psychiatry, law and bioethics, and to work within a collaborative and interdisciplinary research network. I am delighted to have been awarded the Tom Palmer Mental Health Research UK MD(Res) award which will allow me to complete my part-time MD(res) at the Institute of Psychiatry, Psychology and Neuroscience.

Start Date: February 2018

Scientific goal: This project aims to contribute to mental health policy and medical education through exploring what makes a proportion of capacity assessment cases contested or hard, and using this data to produce and test an educational intervention directed at helping clinicians to approach difficult capacity assessments.