Landmark ruling gives patients back the power to challenge doctors' assessments
A High Court judge has overturned a previous decision which stripped a man with mental health problems of his ability to make certain decisions about his own life, including where he lived.
Under the initial ruling, people who disagreed with their psychiatrist could have been found to lack mental capacity to make key decisions, such as where they live, what type of care they should receive, and who they have contact with.
Mind, the leading mental health charity, intervened in the case, and described the ruling as a major victory for people with mental health problems.
The man at the centre of the case, known as CT, has personality disorder, dysexecutive syndrome due to brain injury and cognitive impairment, which doctors felt left him incapable of making decisions about his care needs. In making the initial ruling, the judge applied the clinical concept of ‘insight’ – which is used in psychiatry to determine whether or not someone accepts their diagnosis and prognosis.
His lack of insight into his mental health problems as then used to rule that the man lacked mental capacity – however, Mind successfully argued that there is nothing in legislation that says someone must have insight to be able to make a decision about their care and treatment. Instead, the Mental Capacity Act states that while ‘insight’ can have relevance, it should not be the determining factor. This is particularly important because there are a range of reasons why someone could lack insight – for example if English was not their first language, or if they don’t understand medical issues and language.
Alice Livermore, Head of Legal at Mind, said:
“This is a major victory. If the original decision had been kept in place, it could have had profound impacts on the lives of people with complex mental health problems.
“For example, if someone with mental health problems disagreed with their psychiatrist, they could also be found to lack the mental capacity to make decisions. Taking that decision making power away from people due to a difference of opinion would have been wholly unacceptable and would have set a dangerous precedent.”
