Treatment Decision-Making Capacity in Forensic vs Non-forensic Psychiatric Patients: A European Comparison.

Area of Science:

• Psychiatry
• Forensic Psychiatry
• Mental Health Law

Background:

• Consent to treatment is crucial in medical ethics and law.
• Limited empirical data exists on the decisional capacities of forensic patients with schizophrenia spectrum disorders (SSDs).
• This gap risks clinical inertia, coercion, stigmatization, and flawed reforms.

Purpose of the Study:

• To assess and compare treatment-related decisional capacities in forensic and non-forensic patients with SSDs.
• To identify socio-demographic and clinical variables associated with these capacities.

Main Methods:

• Multinational study involving 160 forensic and 139 non-forensic patients across five European countries.
• Assessment of capacity to consent to treatment using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T).
• Statistical analysis using generalized linear regression models.

Main Results:

• High treatment-related decisional capacity was observed in 34.4% of forensic and 41.7% of non-forensic patients.
• Forensic patients' capacity varied across different countries.
• Social support emerged as the only significant socio-demographic/clinical variable relevant to policy.

Conclusions:

• Forensic patients exhibit comparable treatment-related decisional capacities to their non-forensic counterparts.
• Social support is a key factor in enhancing decisional autonomy for both forensic and non-forensic patients.
• Improving decisional autonomy can enhance the quality and legitimacy of mental health care.