Mental Welfare Commission for Scotland

Consent to treatment/capacity

In each of the wards, people were asked about their understanding of the treatment they were receiving and whether or not they had given consent.

The majority of said they had been given information about their treatment (48 out of 68) but only one had said they had received written information about the medication being administered.

Forty-three out of 68 people had given consent to the treatment they were receiving, with appropriate paperwork in place (T2 forms).

No-one was receiving covert medication at the time of our visits.

Whilst most wards had appropriate paperwork in place to make sure treatment was in line with the 2003 Act (T2/T3 forms), the situation in respect of other treatments for those incapable of consenting was less clear. In four wards, it appeared that paperwork was not in place for people who lacked capacity and whose treatment came under the Adults with Incapacity Act 2000. Six wards had the appropriate certificates in place. In 17 wards there was evidence in the case notes - and from staff interviews - that capacity issues were properly reviewed.These wards also had evidence that welfare proxies, people authorised to consent to medical treatment on behalf of the individual would be consulted. However, staff in other settings commented that they "did not know who is thought incapable of consenting to treatment" and clearly had very little understanding of the importance of these matters.

This lack of understanding and knowledge regarding the Adults with Incapacity Act and the concepts of capacity to consent to treatment is of concern given that many people in this population will have impaired decision making ability. Proper assessment of capacity is essential to ensure that treatment is lawful and is also appropriate for the individual.

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