‘Disorders of the mind v disorders of the brain’

I have decided to write this blog post as every so often I receive referrals for capacity assessments for people with psychiatric disorders. I am not a psychiatrist.

The Mental Capacity Act 2005 specifies that a person has to have evidence of a disorder of the mind or the brain in order to lack mental capacity.

What is the difference?

Disorders of the mind encompass mental health conditions such as bipolar disorder, schizophrenia, PTSD. They fall under the realm of Psychiatry and are diagnosed according to a list of criteria rather than being confirmed by brain scans and laboratory tests. The doctors who treat these patients are psychiatrists, a completely different speciality to my own. If any such patients come under my care in hospital it is for treatment of a medical condition, e.g. heart failure, sepsis.

Disorders of the brain encompass anything that can affect the brain. Such conditions include dementia (a neuro-degenerative condition), strokes, bleeds on the brain and brain tumours amongst others. Delirium is another cause of a disorder of the brain as there is usually an organic cause for delirium, e.g. electrolyte disturbance, infection, deprivation of oxygen (hypoxia). These conditions fall within the realm of my scope of practice which is Internal Medicine. These conditions are generally confirmed by brain scans and laboratory tests.

Thus, the clients I see for capacity assessments have disorders of the brain rather than disorders of the mind. Capacity assessments have to be tailored to the client.

The professional conducting the assessment must be familiar with the condition of the client they are assessing and its treatment, including medications and their side effects.