Understanding clinical decision-making at the interface of the Mental Health Act (1983) and the Mental Capacity Act (2005)

This report explores the context in which the decision of whether to use the MHA or the MCA to authorise a deprivation of liberty is made and the different factors that practitioners use to assess and weigh up which Act is most appropriate and ‘least restrictive’ for the individual concerned. The research used a mixed-methods approach with an online survey to capture the diversity of factors that influence decision-making across clinical groups, and qualitative interviews with clinicians and professionals to explore in depth their understanding of the interface and experiences of making this decision in practice. A large proportion of participants in this research report encountering people to whom this decision applies at least once a month, if not weekly. This decision most commonly applies to people who have dementia, but also to people with a wide range of mental disorders, including those with functional mental illnesses, neurodevelopment and neurological conditions. Participants report most commonly applying this decision to people in community settings, but application also occurs in mental health and acute hospitals including in the emergency department. There is a lack of common understanding around fundamental issues on which this decision is based including core concepts of capacity and objection. Blanket rules exist within professional groups and across different settings that restrict decision-making. The rights afforded to people admitted and treated in some settings and areas of England may not be afforded to those in others. The majority of participants report that their training covered decision-making at the interface of the Acts. However, codes of practice and case law are described as difficult to understand and keep up to date with. Understanding clinical decision-making at the in. Practitioners highlight a number of different ways in which patients are unlawfully deprived of their liberty as a result of the factors outlined above.