Capacity of forensic patients to consent to treatment

Lack of capacity to consent to psychiatric treatment has been promoted as a better basis for compulsion than mental disorder plus risk of harm. Previous research has examined how that legal change would affect acutely unwell inpatients. There is little research on forensic patients. This research aimed to assess capacity to consent in forensic patients at different stages of recovery and to consider the implications of respecting their competent treatment decisions.

Capacity to consent was assessed in a cross-sectional sample of 109 forensic patients both in hospital and in community settings.

The majority of participants (67.6%) had treatment-related decision-making capacity. Very few patients with capacity refused treatment.

Change to a capacity-based legal approach may alter treatment for some forensic patients but would not necessarily increase risk of harm to others. The implications for release decisions are less clear.