Capacity to take mental health care and treatment decisions in patients with major mental illnesses

Abstract Background: The Central Mental Health Authority released the Capacity Assessment Guidance Document (CAGD) to help medical practitioners, and mental health professionals assess the capacity of persons to take mental health care of treatment decisions. The objectives of this study were to determine the proportion of persons remitted from major mental illness having adequate mental capacity to take mental healthcare treatment decisions using CAGD, developed under the Mental Healthcare Act, 2017. Materials and Methods: A cross-sectional observational study was conducted among outpatients with schizophrenia, bipolar disorder, depressive disorder, and unspecified nonorganic psychosis in remission. Sociodemographic and clinical parameters were assessed with a structured questionnaire. Mental capacity was assessed using CAGD issued by the Ministry of Health and Family Welfare. Results: A total of 369 participants were recruited for this study. The mean age of the study participants was 42.6 (standard deviation, 11.77) years. Majority of the participants had a school education, were unemployed, and were married. Out of the 369 participants, 298 (80.76%) were assessed to have the capacity for treatment decisions, and the remaining 71 (19.24%) were reported to need 100% support from the nominated representative to take treatment decisions. Schizophrenia and bipolar affective disorder appear to be associated with lack of mental capacity. Conclusion: About four-fifths of remitted patients with major mental illnesses were assessed to have the capacity to take treatment decisions, and the remaining one-fifth were assessed to need 100% support from a nominated representative to take treatment decisions. Individuals with schizophrenia and bipolar affective disorder were more likely to be judged to need 100% support from a nominated representative.