Severe depression = lacking capacity?

[JellyLellyJenJenBean]

I’m wondering if anyone knows much about the mental capacity act in the UK?

Can you be deemed to lack capacity if suffering from severe depression?

Say someone refuses medication and can clearly explain their reasons why but is too unwell to engage with cbt/therapy or does but finds it unhelpful. Could the CMHT force them to take medication by declaring that they lack capacity?

Or a more subtle route…could social services involved in that situation effectively corner a person into taking it by saying that not accepting treatment would lead to certain repercussions? Thereby saying either comply with treatment and take the medication or else…?

You should discuss all your points with psychiatrist,care coordinator,named worker or see an independent mental health advocate

Are you in England,Wales or Scotland (different legislation)
In Scotland, decision-making in this area is covered by the Adults With Incapacity (Scotland) Act 2000. In England The Mental Capacity Act (MCA) applies

Under MCA capacity is presumed to be present and is not diagnosis specific, Your capacity will need assessed. Professionals can’t presume absence of capacity based on your diagnosis of severe depression

Useful links
MIND uk

Can you be deemed to lack capacity if suffering from severe depression? you’d need a Capacity assessment, but yes if your severe depression affects capacity & decision making

Or a more subtle route…could social services involved in that situation effectively corner a person into taking it by saying that not accepting treatment would lead to certain repercussions? Thereby saying either comply with treatment and take the medication or else…?

CTO
Social services can’t compel you to take medication . Under the MHA 2 psychiatrist and AMHP may assess you for a community treatment order CTO which usually include medication compliance as a condition. CTO is part of mental health act,and allows for community treatment on discharge from hospital.If you have been sectioned and treated in hospital under sections S3 or S37. your responsible clinician can apply for you to be put on a CTO. This means that you can be discharged from the section and leave hospital, but you might have to meet certain conditions

Thanks. Your reply is really helpful.

You could be sectioned and made to have treatment but that’s usually in hospital, and only if you are a risk to yourself or others. Even if you’re a risk to yourself they don’t often section someone with depression.

Capacity assessments are more for social care services, and if someone can hold info long enough in their head, and can make a decision based on available information then they have capacity. People make bad decisions, and are allowed to do so even if they are mentally ill.

Even if you’re a risk to yourself they don’t often section someone with depression
Incorrect an, individual may be detained under MHA if a risk to self and other others and If unsuitable for treatment in community eg with crisis team. It’s about the impact and severity of the mental illness upon the individual and holistically considering all factors. Severe espresso on can be very debilitating and lead to self neglect and or risky behaviour

Capacity assessments are more for social care services, and if someone can hold info long enough in their head, and can make a decision based on available information then they have capacity
Hmm You're sort of on the right track but not completely. capacity assessments are not solely Social care Capacity assessment can be used for healthcare, finances, social care. For example an individual may need a capacity assessment regard accepting treatment or diagnostic tests

Capacity is assessed under MCA. To have capacity a person must be able to:
understand the information that is relevant to the decision they want to make

retain the information long enough to be able to make the decision

weigh up the information available to make the decision

communicate their decision by any possible means, including talking, using sign language, or through simple muscle movements such as blinking an eye or squeezing a hand.

People make bad decisions, and are allowed to do so even if they are mentally ill Correct yes , individuals can and do make unwise decisions. So long as they’re capacitous to do so

Gah,Severe espresso on can be very debilitating and lead to self neglect and or risky behaviour hey be. Careful of a bad coffee, or reckless barista it’s grim out there

And of course I meant Severe depression can be very debilitating and lead to self neglect and or risky behaviour

Yup I used to do capacity assessments and best interests decisions. Mental capacity act is different from the mental health act. If someone can argue the case as to why they won’t take medication, then they’d most likely be judged to have capacity. If they were seriously damaging their health by not engaging in treatment then the mental health act would come in. Mental capacity act stresses the ‘least restrictive option’, and forcing someone to take psychiatric medication would be unlikely to be the least restrictive option. Ppl with dementia often lack capacity over medication but are not forced to take it.

MCA and MHA are different legislation, different scope and different staff undertaking assessments

Yes one isn’t not Not compelled to take medication if they are capacitous and have demonstrated ability to retain info,make a decision,weigh up info with pro/cons.a

Even if you’re a risk to yourself they don’t often section someone with depression. That’s simply not true. It’s a case by case based on the clinical presentation. Severe depression can lead to a hospital admission

The spirit of Mental Health act is least restrictive option,hence crisis team, crisis house will be considered and offered if appropriate. Home treatment as an alternative to admission If safe.

Severe depression can lead to hospital admission yes- however, they try to get ppl in as voluntary patients not to section them. And with the beds crisis people who have severe depression and are at risk to themselves often don’t end up in hospital unless something major happens.

Thanks for both of your replies. It's confusing to understand but it's giving me an idea.

So if something major had happened and someone just managed to avoid being sectioned, refused medication but accepted psychological therapy. If they were unable to fully engage with the therapy or it didn't help. Is there an option to force someone down the medication route after that seeing as they are the only two "treatments".

And where social services and a family support worker say that in order for them to be fully satisfied and that for them to stop supporting a family they need to see the mentally unwell individual engaging in treatment and stable. If that person doesn't respond to psychological therapies and refuses medication at the recommendation of the mental health professionals then can they say that that's not engaging with treatment? Could they then say that if that person is not willing to engage with the treatment (medication) recommended by the CMHT then xyz will happen? Would that not count as cornering and blackmailing into taking the psychological drugs if the child is found to be emotionally, physically and socially on track with no areas of current concern? Saying that that may change in the future surely isn't enough?

Sorry, lots of questions. It's just such a big area to wrap my head around. And it's a nightmare knowing which professionals to trust.

Social services deemed me as unfit parent when I was sent to hospital. I was voluntery patient and I did engage on everything in order to get kids back. Before that I had resisted medication and it hasn't been really forced on me. That wasn't the reason for hospitalisation. Anyway I got very motivated to get better and accepted medication and I didn't try to get out of hospital when I was still unwell.

Jelly, I strongly advise attend a Case conference review your plan and the treatment
All sides have an open transparent conversation
What’s working
What could be improved upon
Your preference
What the profession advice is

And it's a nightmare knowing which professionals to trust ok so that’s the core of what your expressing,and I’d advise an honest cards on table discussion you, the professionals

I genuinely wish you well at what seems to be a difficult time

Thanks. Have a multi-agency meeting thingy soon. Will try to raise the conversation then. Just playing on my mind for now. Thank you.

I’d guess from the 1st scenario, nope, couldn’t force medication.

The 2nd situation (with kids) is different though. The only reason I take my meds consistently is that my kids would be taken off me if I didn’t. Social services are usually willing to work with people if they are mentally unwell but engaging with treatment. Refusing to take medication despite requests of MH team could count as not engaging fully. Although the child might be ok at the moment having a severely depressed parent, if they aren’t able to fulfill their role fully, will end up affecting the child. If they don’t know already, having it pointed out exactly how having an untreated depressed parent affects a child could maybe encourage someone to try medication.

Thanks for your experiences solarscope and dangermouseisace. It's really helpful to hear what you have experienced. It's scary to try and navigate this.