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Assessment of mental capacity in people with learning disabilities involved in criminal proceedings has been debated, and the introduction of mental capacity legislation in the United Kingdom makes provisions for people who lack the capacity to make decisions about their welfare. However, while the new legislation is designed to protect people who lack the mental capacity to make decisions, it is not clear how this legislation applies in criminal cases where the capacity to consent to sexual relations has been questioned. Until recently there was no clear definition of capacity to consent to sexual relations, and the aim of this paper is to consider the key aspects of this legislation and apply it to a case example. The definitions and assessment procedures involved in assessing ‘mental capacity’ are considered, and practice guidance for mental health professionals working in this field is offered.

The purpose of this paper is to consider the impact of mental capacity legislation when applied to parents with learning difficulties who lack capacity within childcare and family law proceedings in England and Wales.

The paper relies on a range of material including reports published by independent mental health foundations, official inquiries and other public bodies. It also refers to academic and practitioner material in journals and government guidance.

The paper critically reviews the application of the guidance when assessing mental capacity legislation as applied in England and Wales and offers by way of illustration several case examples where psychological assessments, and the enhancement of capacity, have assisted parents who were involved in childcare and family law proceedings.

There has been little published research or governmental reports on the number of cases when parents involved in childcare and family law proceedings have been found to lack capacity. No published prevalence data are available on the times when enhancing capacity has resulted in a change of outcome in childcare and family law proceedings.

The duty is on the mental health practitioners assessing mental capacity that they do so in a structured and supportive role adhering to good practice guidance and follow the guiding principles of mental capacity legislation assuming that the individual has capacity unless it is established that they lack capacity. Guidance and training is needed to ensure that the interpretation of the Mental Capacity Act (MCA) and its application is applied consistently.

For those who are considered to lack mental capacity to make specific decisions, particularly within childcare and family law proceedings, safeguards are in place to better support such individuals and enhance their capacity in order that they can participate more fully in proceedings.

While the MCA legislation has now been enacted for over ten years, there is very little analysis of the implications of capacity assessments on parents involved in childcare and family law proceedings. This paper presents an overview and, in places, a critical analysis of the new safeguarding duties of mental health practitioners when assessing for, and enhancing capacity in parents.

The purpose of this paper is to explore the consequences for older people’s mental wellbeing of understandings relating to the Mental Capacity Act 2005 (MCA). The MCA seeks to maximise people’s abilities to make decisions and provides a framework for decisions to be made in a person’s best interests should they lack the mental capacity to do so themselves (Graham and Cowley, 2015). Practice varies widely amongst health and social care practitioners and little is known about the nature of interventions under the MCA or the outcomes for service users’ lives and health, especially their mental health and emotional wellbeing.

By reflecting upon existing evidence this position paper offers a narrative of how practice in applying the principles of the MCA may impact upon the mental wellbeing of older people. Drawing upon court of protection judgements and existing research the author analyses the way the MCA is understood and applied and how institutional mechanisms might hinder good practice.

There are tensions between policy imperatives and examples of practice linked to the MCA, the spirit of the MCA and tenets of good practice. Despite efforts on promoting choice, control and rights there is growing paradoxical evidence that the MCA is used as a safeguarding tool with the consequences that it constrains older people’s rights and that it may encourage risk averse practice. The consequences of this for older people are considerable and include lack of choice, autonomy and self-determination. This discussion suggests that anxiety in relation to the application of the MCA stills exists in practice and that maximising older people’s capacity and supporting decision making is central in promoting mental health and wellbeing.

This position paper will identify how the MCA might be interpreted in action through consideration of existing evidence. This paper may lead to future research on how understandings of the MCA are constructed and what values underpin its application from conception to outcomes in relation to understandings of risk, risk aversion, decision making and the potential and need for emancipatory practice. Essentially, the paper will discuss how the MCA actually seeks to enhance the mental health and emotional wellbeing of older adults by offering a rather radical approach to understanding people’s wishes and feelings, but how attitudes may lead to misunderstandings and negative outcomes for the individual.

In a climate of serious case reviews identifying concerns and abuses in care it is imperative that understanding of the MCA inform good practice. However, what constitutes good practice requires unravelling and the agendas, requirements and attitudes of interventions need considering from an epistemological perspective as well as to project how the outcomes of decision-making impact upon the mental health of older adults. This paper will discursively add value to the narrative around how the MCA is applied in practice and how chosen practice often constructs the mental wellbeing of older adults.

This article aims to bring readers up to date with policy developments in England and Northern Ireland in the last two years since the journal first reported on these issues.

As well as looking at changes to policy and legislation, the paper highlights not only the differences but also the shared concerns for people with intellectual disability living in the two countries, e.g. equal access to healthcare as experienced by the general population.

In spite of shared visions of inclusion and equality in mental health care, there are major differences in how both countries approach these issues. Recently this has been highlighted by significant shifts in policy. In Northern Ireland strategies designed to inform the delivery of evidence based services for the future have been witnessed. Whilst in England there has also been a move towards public protection within mental health legislation and the reaffirmation of the need to move towards more individual services. Whilst policy initiatives in both countries have been encouraging; they need to be implemented so issues such as access to healthcare and geographical disparity are addressed by local providers.

Although there is a desire for change, the reality is that the policies and legislation introduced to address issues such as accessing mental health care and service standards have still to make a significant impact to people's daily lives.

This paper offers an update of current practice and policy relating to mental health for people with intellectual disabilities in England and Northern Ireland.

The purpose of this paper is to demonstrate that the common and statutory law governing children's capacity or competence to consent to and to refuse medical treatment is unsatisfactory and to suggest solutions.

Critical legal analysis of the law on assessing minors’ decision-making capacity in relation to legal recognition of their consent to and refusal of medical treatment.

Without legal mechanisms which protect both children and their rights, all children and young people are effectively disabled from exercising age and capacity-related autonomy and participation in decisions affecting their lives. Yet in English law, inconsistencies between legal and clinical measures of decision-making capacity, situations where compulsory medical or mental health treatment is lawful, and tensions between rights and duties associated with human rights, autonomy, best interests and protections for the vulnerable create difficulties for clinicians, lawyers and patients.

As the paper acknowledges in its recommendations, the views of stakeholders are needed to enrich and inform legal reforms in this area.

The paper makes suggestions to amend the law and clinical practice which are original and far reaching. The paper suggests that in order to observe children's rights while protecting them appropriately, the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards should be applied to minors. The paper recommends the establishment of Mental Capacity Tribunals, similar in nature and purpose to Mental Health Tribunals, to provide legal safeguards and mechanisms to foster the supported decision-making envisaged in recent United Nations Conventions.

The purpose of this paper is to explore the clinical implications of the case of AM and the ruling that the Mental Health Act no longer has primacy over other legislation in certain treatment situations.

Critical case analysis and discussion.

The Mental Capacity Act Deprivation of Liberty Safeguards could be used more widely, and in preference to the Mental Health Act, but this may cause problems to clinicians and other decision makers such as Mental Health Tribunals.

This case and its findings have not been widely discussed in academic or clinical practice literature.

The terms capacity and competence are often used interchangeably, but are actually distinct. This aim of this paper is to clarify the application of these terms, and to illustrate some of the practical benefits of distinguishing them.

The concepts of capacity and competence are discussed in relation to restrictions that are placed on choice and action, respectively, when these qualities are judged to be absent. The paper explores the distinction between these two concepts in relation to their legal status, assessment, and scope.

Mental capacity refers to the ability to make decisions, while competence refers to the ability to perform the actions needed to put decisions into effect. Questions of capacity are governed by legislation (in the UK: the Mental Capacity Act (MCA); the Adults with Incapacity (Scotland) Act and the Sexual Offences Act); they apply only to people who can be demonstrated to have a “mental disorder”, and trigger best‐interests decision making and other legal provisions if capacity is assessed as absent. Questions of competence involve a range of formal and informal assessment procedures, and can apply to anyone; they arise where others possess legal powers to control a person's actions.

In addition to clarifying the conceptual confusion that exists in this area, the paper also considers some areas of practice where the MCA can be invoked to promote competence, in addition to capacity.

2007 marks a major step forward in the history of adult protection with the implementation of the Mental Capacity Act in England and Wales. Understandably, debates about adult protection have usually focused on the more obvious types of abuse ‐ sexual, physical, financial and emotional. The Mental Capacity Act addresses a much wider issue of abuse where a person's right to make their own decisions, and to have proper safeguards and protection if decisions need making on their behalf, is overridden or ignored. This article gives an overview of the Mental Capacity Act and its relevance to the files of adult protection.

The assessment and management of prisoners on hunger strikes in a custodial setting is complex. There is limited clinical guidance available for psychiatrists to draw upon in such cases. The purpose of this paper is to develop a management algorithm through expert elicitation to inform the psychiatric care of prisoners on a hunger strike.

A Delphi method was used to elicit views from Irish forensic psychiatrists, a legal expert and an expert in ethics using a structured questionnaire. Themes were extracted from the results of the questionnaire to propose a management algorithm. A consensus was reached on management considerations.

Five consultant forensic psychiatrists, a legal expert and an expert on psychiatric ethics (n=7) consented to participation, with a subsequent response rate of 71.4 per cent. Consensus was achieved on a proposed management algorithm. Assessment for mental disorder, capacity to refuse food and motivation for food refusal are seen as key psychiatric tasks. The need to work closely with the prison general practitioner and the value of multidisciplinary working and legal advice are described. Relevant aspects of law included mental health, criminal law (insanity) and capacity legislation.

This study outlines a management algorithm for the psychiatric assessment and management of prisoners on a hunger strike, a subject about which there is limited guidance to date. Although written from an Irish perspective, this study outlines key considerations for psychiatrists in keeping with international guidance and therefore may be generalisable to other jurisdictions.