Capacity to consent

This section is for questions relating to therapy, assessment, formulation and other aspects of working with people in mental health services.

Post Reply
Gutisomama
Posts: 16
Joined: Wed Sep 30, 2009 11:33 am

Capacity to consent

Post by Gutisomama » Wed Dec 07, 2011 1:19 pm

Hi,

I am hoping to obtain some opinions about an Intellectual Disability client case. I am going to meet for the first time with this [age removed] years old pregnant woman who has mild learning disability for an assessment of whether she has the capacity to consent and sign the form stating that she and her baby, when born will be required to live in a foster care home. I guess that my role will be evaluating whether she has the capacity to consent. I have never done this assessment before. The social worker, the referral agent, wants to know my clinical opinion whether she is able to understand the consequences of whatever decision she makes. I know there is a functional assessment that can used but I don't much about that? I am not sure what approach to use. is there a structured form available to use during the session with her?
I would also like to have some opinions on the report format and any book where I can find a model of writing this kind of report? Also, is it not the role of the psychiatrist to make this assessment?

Gutisomama

User avatar
maven
Site Admin
Posts: 2189
Joined: Sat Mar 24, 2007 9:00 pm

Re: Capacity to consent

Post by maven » Wed Dec 07, 2011 1:48 pm

It seems to me like the task is beyond your current competence, but it is something plenty of CPs are competent at and do fairly regularly. If you are a qualified CP, surely you have a supervision and support structure that would help to define your role and identify any training needs if you are being asked to do things outside your competence?

I'm also worried about the fact you've shared unnecessary client information in your post (which together with information from your other posts which give your name and location mean that the specific client would be able to be identified), so much so I'm going to edit out the age of the client in your post!
Maven.

Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare

charley
Posts: 151
Joined: Tue Jul 24, 2007 2:20 pm
Location: Devon

Re: Capacity to consent

Post by charley » Wed Dec 07, 2011 2:02 pm

I would agree with Maven. If you are a qualified CP then a supervisor or someone who has done this before can steer you through the assessment as they are quite tricky. If you are not qualifed then i think its beyond your area of competence, adn i would be very careful before taking it on, as you could end up in court defending your decision and report. It sounds like a good starting point would be reading the BPS guidance on capacity and the links to the Mental Capacity Act itself.
Often other professionals want these things done "quickly" but don't be pushed into anything you don't fully understand, as the report will have your name on it and will be yours to own.

User avatar
Borrowed Cone
Posts: 1269
Joined: Fri Nov 12, 2010 11:05 pm
Location: M25

Re: Capacity to consent

Post by Borrowed Cone » Wed Dec 07, 2011 4:09 pm

My understanding from your previous posts is that you are a qualified Educational Psychologist?

Otherwise, I agree with the above posts.
"We can rebuild him. We have the technology. But I don't want to spend a lot of money..."

Gutisomama
Posts: 16
Joined: Wed Sep 30, 2009 11:33 am

Re: Capacity to consent

Post by Gutisomama » Wed Dec 07, 2011 10:04 pm

Thanks Charley for these good advice. I agree that I should not be pushed into something that I don't fully understand at this stage especially that Learning Disability is not my area of expertise. The BPS guidelines about capacity to consent is a very good reference.

User avatar
choirgirl
Posts: 1440
Joined: Thu Apr 05, 2007 9:41 am
Location: Midlands

Re: Capacity to consent

Post by choirgirl » Fri Dec 09, 2011 2:45 pm

Borrowed Cone wrote:My understanding from your previous posts is that you are a qualified Educational Psychologist?
Gutisomama is an Irish-trained clinical psychologist (as described here), who also has a Masters in Ed Psych (which, depending on when they completed this, doesn't necessarily make them a qualified Educational Psychologist).
"Music washes away from the soul the dust of everyday life." - Red Auerbach

User avatar
Borrowed Cone
Posts: 1269
Joined: Fri Nov 12, 2010 11:05 pm
Location: M25

Re: Capacity to consent

Post by Borrowed Cone » Fri Dec 09, 2011 10:22 pm

choirgirl wrote:
Borrowed Cone wrote:My understanding from your previous posts is that you are a qualified Educational Psychologist?
Gutisomama is an Irish-trained clinical psychologist (as described here), who also has a Masters in Ed Psych (which, depending on when they completed this, doesn't necessarily make them a qualified Educational Psychologist).
Thank you for clarification.
"We can rebuild him. We have the technology. But I don't want to spend a lot of money..."

Gutisomama
Posts: 16
Joined: Wed Sep 30, 2009 11:33 am

Re: Capacity to consent

Post by Gutisomama » Sat Dec 10, 2011 8:05 am

Yes Choirgirl,I am not an Ed Psychologist. I have completed my clinical training and my query about the capacity to consent following my dilemmas about doing the functional assessment or not was answered in the BPS Guidelines (thanks Charley for the advice). As I work in a primary care setting, I was asked to carry out this assessment while there were other people in the service with speciality in LD and already having experience in this type of assessment. I was unsure (before reading the BPS Guidelines on capacity to consent) how ethical it was, for me as a clinical psychologist (with no experience in this type of assessment) to claim that I could carry out this type of assessment. This question was answered in the BPS Guidelines in the competency section. Thanks for your contribution.

Scottybottybanana
Posts: 104
Joined: Sat Aug 15, 2009 2:09 pm

Re: Capacity to consent

Post by Scottybottybanana » Sun Dec 11, 2011 2:23 pm

Gutisomama wrote:Hi,

I am hoping to obtain some opinions about an Intellectual Disability client case. I am going to meet for the first time with this [age removed] years old pregnant woman who has mild learning disability for an assessment of whether she has the capacity to consent and sign the form stating that she and her baby, when born will be required to live in a foster care home. I guess that my role will be evaluating whether she has the capacity to consent. I have never done this assessment before. The social worker, the referral agent, wants to know my clinical opinion whether she is able to understand the consequences of whatever decision she makes. I know there is a functional assessment that can used but I don't much about that? I am not sure what approach to use. is there a structured form available to use during the session with her?
I would also like to have some opinions on the report format and any book where I can find a model of writing this kind of report? Also, is it not the role of the psychiatrist to make this assessment?

Gutisomama

Heres some tools and reviews RE: Capacity to consent.

Lapid et al 2004 (J. Geriatric Psychiatry & Neurology): using McCAT-T for ECT consent; evaluated effect of training
Moye et al 2004 (Gerontology) comparing 3 tools for measuring capacity to consent in older people
Palmer et al 2005 (Arch. General Psychiatry): validating a three item screening q’aire against McCAT-R – for research
Raymont et al 2007 (International J. of Law & Psychiatry) comparing two tools for measuring capacity to consent
Saks et al 2002 (Am J Geriatric Psychiatry): tool for measuring ‘appreciation’ component
Owen et al (2009) Mental capacity & psychiatric in-patients… BJPsychiatry 195, 257-263
Moye et al (2006) Advances in assessment. See Clinical Psychology Review, 26, 1054-1077
Sturman (2005) (a review of assessment tools) See Clinical Psychology Review, 25, 954-974
Okai et al (2007) Mental capacity in psychiatric patients: a systematic review. British Journal of Psychiatry, 191, 291-7

The public Guardian also has good info:
http://www.justice.gov.uk/guidance/prot ... /index.htm

The IMCA service are good.
http://www.dh.gov.uk/en/SocialCare/Deli ... /index.htm

Gutisomama
Posts: 16
Joined: Wed Sep 30, 2009 11:33 am

Re: Capacity to consent

Post by Gutisomama » Sun Dec 11, 2011 2:31 pm

Thanks Scottybottybanana. Those references are going to be very useful.

annabel_h
Posts: 61
Joined: Thu May 27, 2010 2:24 pm

Re: Capacity to consent

Post by annabel_h » Mon Dec 12, 2011 11:12 am

I seem to remember a few years ago my mum, who at the time was a Care Manager in the LD social services team, having to do quite a full on training course and get accredited to allow her to assess capacity to consent. Obviously I know social work is different to CP, but my point is that it isn't something to undertake lightly, and if you don't feel you have the skills to do it I would be very wary.... Are there other CPs you work with who can guide you?

Scottybottybanana
Posts: 104
Joined: Sat Aug 15, 2009 2:09 pm

Capacity to consent

Post by Scottybottybanana » Mon Dec 12, 2011 2:38 pm

annabel_h wrote:I seem to remember a few years ago my mum, who at the time was a Care Manager in the LD social services team, having to do quite a full on training course and get accredited to allow her to assess capacity to consent. Obviously I know social work is different to CP, but my point is that it isn't something to undertake lightly, and if you don't feel you have the skills to do it I would be very wary.... Are there other CPs you work with who can guide you?
She can use the IMCA service that I linked above. They're free.

annabel_h
Posts: 61
Joined: Thu May 27, 2010 2:24 pm

Re: Capacity to consent

Post by annabel_h » Mon Dec 12, 2011 4:15 pm

ah ha, maybe that's what my mum trained to be!

Gutisomama
Posts: 16
Joined: Wed Sep 30, 2009 11:33 am

Re: Capacity to consent

Post by Gutisomama » Mon Dec 12, 2011 8:32 pm

I am getting some support with other CP who has experience in this type of assessment and this was also brought to peer supervision. At this point my assessment is inconclusive as the client seemed to have the capacity to understand and retain only positive information about the foster care. Social worker did not seem to have discussed the alternatives and consequences of not signing the foster care form with the client which would not allow her to make an informed consent. I may need to refer to a psychiatrist for a second opinion :?

Post Reply

Who is online

Users browsing this forum: No registered users and 2 guests