National survey of training of psychiatrists on advance directives to refuse treatment in relation to bipolar disorder

Aims and Methods: To determine features associated with better perceived quality of training for psychiatrists on advance decision-making in the Mental Capacity Act (MCA), and whether the quality or amount of training were associated with positive attitudes or use of advance decisions to refuse treatment (ADRTs) by psychiatrists in people with bipolar disorder (BD). An anonymised national survey of 650 trainee and consultant psychiatrists in England and Wales was performed. Results: Good or better quality of training was associated with use of case summaries, role-play, ADRTs, assessment of mental capacity and its fluctuation. Good or better quality and two or more sessions MCA training were associated with more positive attitudes and reported use of ADRTs, although many psychiatrists would never discuss them clinically with people with BD. Clinical implications: Consistent delivery of better quality training is required for all psychiatrists to increase use of ADRTs in people with BD

National survey and analysis of barriers to the utilisation of the 2005 Mental Capacity Act by people with bipolar disorder in England and Wales

Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity e.g. through mania or severe depression. Aims: To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation. Methods: National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD. Results: 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. 199 (36.6%) participants knew about the MCA. 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney respectively. Barriers included not understanding its different forms, unrealistic expectations and advance plans ignored by services. Conclusion: In BD the demand for advance plans about welfare with loss of capacity was high but utilisation of the MCA was low with barriers at service user, clinician and organisation levels

Planning for incapacity by people with bipolar disorder under the Mental Capacity Act 2005

The Mental Capacity Act 2005 provided a variety of legal mechanisms for people to plan for periods of incapacity for decisions relating to personal care, medical treatment, and financial matters. Little research has however been done to determine the degree to which these are actually implemented, and the approach to such advance planning by service users and professionals. This paper looks at the use of advance planning by people with bipolar disorder, using qualitative and quantitative surveys both of people with bipolar disorder and psychiatrists. The study finds that the mechanisms are under-used in this group, despite official policy in support of them, largely because of a lack of knowledge about them among service users, and there is considerable confusion among service users and professionals alike as to how the mechanisms operate. Recording is at best inconsistent, raising questions as to whether the mechanisms will be followed

Capacity assessment and decision-making for the incapable patient in English, Scottish and Indian law

This PhD thesis has two core objectives: 1) To critically analyse and compare the legal provisions relating to capacity assessment in England and Wales, Scotland and India 2) To critically analyse and compare the legal provisions relating to decision-making on behalf of the incapable patient in England and Wales, Scotland and India. The methodology utilised to achieve these objectives is essentially a classic literature based comparative approach. This thesis provides an original contribution to knowledge by virtue of the fact that an in-depth tripartite comparative study of capacity law provisions in England and Wales, Scotland and India has Yet to be undertaken within existing literature. The research undertaken in this thesis is timely given the implementation of capacity legislation in England and Wales and the relevant provisions of the Mental Capacity Act 2005 of England and Wales and the Adults with Incapacity (Scotland) Act 2000 are compared and critiqued as part of a discussion of the key ethical, legal and procedural concepts which underpin the law of capacity. In addition, the capacity law of England and Scotland is compared with the equivalent system in Indian law, which is at a nascent stage of development in comparison to the United Kingdom. The fact that India, despite being an Eastern country, also retains the influence of U. K law through its status as a Commonwealth country, means that the differences between the English, Scottish and Indian approaches to capacity can be attributed to issues of culture or development. The research undertaken for this thesis has shown that developmental issues are of greater impact, and while cultural issues are of some relevance, there are enough underlying commonalities between the three jurisdictions to suggest that India's capacity law is at a different point developmentally speaking.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

National survey of training of psychiatrists on advance directives to refuse treatment in bipolar disorder

Aims and method To determine features associated with better perceived quality of training for psychiatrists on advance decision-making in the Mental Capacity Act 2005 (MCA), and whether the quality or amount of training were associated with positive attitudes or use of advance decisions to refuse treatment (ADRTs) by psychiatrists in people with bipolar disorder. An anonymised national survey of 650 trainee and consultant psychiatrists in England and Wales was performed. Results Good or better quality of training was associated with use of case summaries, role-play, ADRTs, assessment of mental capacity and its fluctuation. Good or better quality and two or more sessions of MCA training were associated with more positive attitudes and reported use of ADRTs, although many psychiatrists would never discuss them clinically with people with bipolar disorder. Clinical implications Consistent delivery of better-quality training is required for all psychiatrists to increase use of ADRTs in people with bipolar disorder