‘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 / symptoms, with no reliance on laboratory tests and brain scans. 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. The psychiatrist is typically involved to manage the pre-existing mental health condition. I do not conduct capacity assessments for people with psychiatric disorders.

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 also a disorder of the brain as its causes are ‘organic’, e.g. electrolyte disturbances, infections, deprivation of oxygen to the brain (hypoxia), high levels of carbon dioxide etc. These conditions fall within the realm of my scope of practice (Internal Medicine) and are generally confirmed by brain scans and/or laboratory tests.

Geriatric Medicine is a sub-speciality of Internal Medicine which concerns itself with the healthcare of the over 65s. Dementia, Parkinson’s and delirium typically affect this age group.

Thus, the clients I see for capacity assessments are older people with 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.