Why I don’t accept all referrals for capacity assessments

A blog post on this topic was necessary because I routinely turn down requests for capacity assessments of young people with learning disabilities and mental health problems. Requests are received from both solicitors and members of the public. The reason I refuse the referrals is because my clinical speciality is geriatric medicine, also referred to as ‘care of the elderly’ or medicine of older people. Typically, patients in this category are over 65 but there is some flexibility if a person under this age has dementia, Parkinson’s or any other cause of frailty.

A doctor of older people treats any medical condition that brings older people to hospital, e.g. falls, infections, delirium. Many such patients have dementia. Mental capacity assessments of older people are routinely carried out by doctors for a number of decisions related to their medical treatment or potential deprivation of liberty.

Even though I also practise general internal medicine - meaning that I treat hospital patients younger than 65 - this demographic rarely needs capacity assessments.

Doctors in the UK are regulated by the General Medical Council who make it very clear that we should be working within our competencies, in other words within our specialities. Additionally, there is a requirement that doctors be indemnified for every aspect of their practice. My indemnity provider (quite rightly) will not cover me for conducting capacity assessments of people with schizophrenia / bipolar disorder or learning disabilities, and a Court of Protection judge would most definitely question me (and likely admonish me) if I were to undertake such an assessment. This is because I do not treat these patients in my clinical capacity. My law degree does not give me the green light to carry out capacity assessments on everyone who may need one.

The assessment of mental capacity has to be tailored to the individual concerned; it is not a tick box exercise with a ‘one size fits all’ approach. Being familiar with the conditions of clients requiring these assessments is absolutely essential, including knowledge of their medications (if applicable). It is unethical to not comply with this.

Sometimes, patients with learning disabilities and mental health conditions come under my care in hospital, but they do so for medical issues such as infections and heart failure which I treat. If I am concerned about the mental health of a patient admitted under my care, I refer them to the psychiatrist.