Mental Capacity Assessments Among Inpatients Referred to the Consultation-Liaison Psychiatry Unit at a University Hospital in Bangkok, Thailand.

Abstract

Clinicians routinely assess patients' mental capacity on a daily basis, but a more thorough assessment may be needed in complex cases. We aimed to identify the characteristics of inpatients in a general hospital, who were referred to a liaison psychiatry service for mental capacity assessment, reasons for the referrals, and the factors associated with their mental capacity. A 6-year retrospective study (2008-2013) was conducted using data collected routinely (e.g., age, gender, diagnosis, Thai Mental State Examination score, reasons for the referral, and the outcome of capacity assessment) on referrals for mental capacity assessment to a Consultation-liaison Psychiatry Unit at a university hospital in Thailand. Among 6194 consecutive referrals to the liaison-psychiatry services, only 0.6% [n=37, mean age (SD), 59.83 (20.42)] were referred for capacity assessment, 43.24% of which lacked mental capacity. The most common requests from referring physicians were for assessment of testamentary capacity (15 assessed, 53.33% lacking capacity), financial management capacity (14 assessed, 50% lacking capacity), and capacity to consent to treatment (9 assessed, 22.22% lacking capacity). Delirium, rather than dementia or other mental disorders, was associated with mental incapacity (p<0.001) and being more dependent during the admission (p=0.048). There were no significant differences for mean age (p=0.257) or Thai Mental State Examination score (p=0.206). The main request from referring clinicians was to assess testamentary capacity. Delirium and being more dependent during the admission were associated with lack of mental capacity, whereas age and dementia were not.