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Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting

INTRODUCTION: Impairment in decision-making capacity is a serious consequence of executive dysfunction secondary to serious mental disorders like schizophrenia. Functional mental capacity (FMC) refers to an individual’s ability to make and communicate legally competent decisions autonomously. Studie...

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Autores principales: Tong, K., Har, C., Kennedy, H., Davoren, M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9564983/
http://dx.doi.org/10.1192/j.eurpsy.2022.888
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author Tong, K.
Har, C.
Kennedy, H.
Davoren, M.
author_facet Tong, K.
Har, C.
Kennedy, H.
Davoren, M.
author_sort Tong, K.
collection PubMed
description INTRODUCTION: Impairment in decision-making capacity is a serious consequence of executive dysfunction secondary to serious mental disorders like schizophrenia. Functional mental capacity (FMC) refers to an individual’s ability to make and communicate legally competent decisions autonomously. Studies have shown that FMC is dependent on severity of psychosis and can improve with treatment. OBJECTIVES: To ascertain the correlation between the scores on a structured judgement tool, namely the Dundrum Capacity Ladders (DCL) with level of acuity of treatment setting and length of stay in a secure forensic hospital. METHODS: Sixty-two patients were interviewed using the DCL across three domains – healthcare, welfare and finances. Correlation between DCL scores, length of hospital stay and level of acuity of treatment setting was assessed. RESULTS: As patients moved from higher to lower dependency wards, mean DCL score increased, indicating a higher level of capacity. Patients in high dependency wards were most impaired while those in the low dependency wards performed significantly better (r(s)=0.472, p<0.001). The longer the patients stayed in the hospital, up until five years, the higher the mean welfare domain score (r(s)=0.402, p=0.011) and mean DCL score (r(s)=0.376, p=0.018). Beyond five years of hospital stay, those who had lower DCL scores and did not improve had longer length of stay. CONCLUSIONS: Patients’ FMC improve as they progress from high to low level of acuity of treatment setting. However, this is dependent on the length of hospital stay. FMC may be a measure of recovery in the forensic setting. DISCLOSURE: No significant relationships.
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spelling pubmed-95649832022-10-17 Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting Tong, K. Har, C. Kennedy, H. Davoren, M. Eur Psychiatry Abstract INTRODUCTION: Impairment in decision-making capacity is a serious consequence of executive dysfunction secondary to serious mental disorders like schizophrenia. Functional mental capacity (FMC) refers to an individual’s ability to make and communicate legally competent decisions autonomously. Studies have shown that FMC is dependent on severity of psychosis and can improve with treatment. OBJECTIVES: To ascertain the correlation between the scores on a structured judgement tool, namely the Dundrum Capacity Ladders (DCL) with level of acuity of treatment setting and length of stay in a secure forensic hospital. METHODS: Sixty-two patients were interviewed using the DCL across three domains – healthcare, welfare and finances. Correlation between DCL scores, length of hospital stay and level of acuity of treatment setting was assessed. RESULTS: As patients moved from higher to lower dependency wards, mean DCL score increased, indicating a higher level of capacity. Patients in high dependency wards were most impaired while those in the low dependency wards performed significantly better (r(s)=0.472, p<0.001). The longer the patients stayed in the hospital, up until five years, the higher the mean welfare domain score (r(s)=0.402, p=0.011) and mean DCL score (r(s)=0.376, p=0.018). Beyond five years of hospital stay, those who had lower DCL scores and did not improve had longer length of stay. CONCLUSIONS: Patients’ FMC improve as they progress from high to low level of acuity of treatment setting. However, this is dependent on the length of hospital stay. FMC may be a measure of recovery in the forensic setting. DISCLOSURE: No significant relationships. Cambridge University Press 2022-09-01 /pmc/articles/PMC9564983/ http://dx.doi.org/10.1192/j.eurpsy.2022.888 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Tong, K.
Har, C.
Kennedy, H.
Davoren, M.
Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting
title Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting
title_full Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting
title_fullStr Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting
title_full_unstemmed Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting
title_short Decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting
title_sort decision-making capacity regarding healthcare, welfare and finances in a secure forensic setting
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9564983/
http://dx.doi.org/10.1192/j.eurpsy.2022.888
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