University Advancement Board of Trustees Orientation Dr. Brendan Kelly.
Brendan Kelly - HSE.ie · 2019-12-18 · Brendan Kelly . 1. Numbers 2. Capacity 3. MHA 2001 4....
Transcript of Brendan Kelly - HSE.ie · 2019-12-18 · Brendan Kelly . 1. Numbers 2. Capacity 3. MHA 2001 4....
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Assisted Decision Making (Capacity) Act 2015
as a conduit for realising
human rights in mental health
Brendan Kelly
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1. Numbers
2. Capacity
3. MHA 2001
4. Conclusions
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Globally, suicide
has fallen by a
third since 1990
Travelling community
Children
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Eurostat
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Other indices
Murder suicide < 2 per year
(one fifth of US rate)
Involuntary admissions 47/100,000 per year
(half of English rate)
Anti-depressant use
RRR
Anti-depressant: 58%
Aspirin: 19%
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7.2%
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Crisis
narrative
Problem-
solving
narrative
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1. Numbers
2. Capacity
3. MHA 2001
4. Conclusions
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1. Numbers
2. Capacity
3. MHA 2001
4. Conclusions
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“Capacity”
vs
“Disability”
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• Presumption of capacity
• Functional assessment
Understand
Retain
Use or weigh up
Communicate
• Insight
• Cognition and executive function
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1. Decision-making assistant
2. Co-decision-maker
3. Decision-making representative
No
Cir
cuit
Co
urt
Cir
cuit
Co
urt
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1. Decision-making assistant
2. Co-decision-maker
3. Decision-making representative
0%
? 50%
100%
How much decision-making
authority is given away?
No
Cir
cuit
Co
urt
Cir
cuit
Co
urt
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2018
17,000 psychiatry admissions
650,900 medical admissions
27,000 people in nursing homes
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Medical and
surgical
inpatients
Full mental capacity
Partial mental capacity
Lack mental capacity
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Medical and
surgical
inpatients
(n=300)
Ruth Murphy
Full mental capacity
Partial mental capacity
Lack mental capacity
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Medical and
surgical
inpatients
(n=300)
Ruth Murphy
Full mental capacity 71%
Partial mental capacity
Lack mental capacity
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Medical and
surgical
inpatients
(n=300)
Ruth Murphy
Full mental capacity 71%
Partial mental capacity 2%
Lack mental capacity
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Medical and
surgical
inpatients
(n=300)
Ruth Murphy
Full mental capacity 71%
Partial mental capacity 2%
Lack mental capacity 28%
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Medical and Psychiatry
surgical inpatients
inpatients (n=215)
(n=300)
Ruth Murphy Aoife Curley
Full mental capacity 71%
Partial mental capacity 2%
Lack mental capacity 28%
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Medical and Psychiatry
surgical inpatients
inpatients (n=215)
(n=300)
Ruth Murphy Aoife Curley
Full mental capacity 71% 47%
Partial mental capacity 2%
Lack mental capacity 28%
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Medical and Psychiatry
surgical inpatients
inpatients (n=215)
(n=300)
Ruth Murphy Aoife Curley
Full mental capacity 71% 47%
Partial mental capacity 2% 51%
Lack mental capacity 28%
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Medical and Psychiatry
surgical inpatients
inpatients (n=215)
(n=300)
Ruth Murphy Aoife Curley
Full mental capacity 71% 47%
Partial mental capacity 2% 51%
Lack mental capacity 28% 2%
older, unmarried, not
working outside home,
more diagnoses
involuntary, non-Irish,
unemployed, older
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Voluntary Involuntary
n=176 n=39
Full mental capacity 58%
Partial mental capacity 40%
Lack mental capacity 2%
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Voluntary Involuntary
n=176 n=39
Full mental capacity 58% 0%
Partial mental capacity 40% 100%
Lack mental capacity 2% 0%
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1. Numbers
2. Capacity
3. MHA 2001
4. Conclusions
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1. Numbers
2. Capacity
3. MHA 2001
4. Conclusions
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• Advance healthcare directives
• Definition of voluntary patient
• “In good faith and for the benefit of”
• Diagnosis
• Unwise decisions
• Recovery
There are no insurmountable problems
with the interaction between the two Acts
What diagnosis?
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1. Numbers
2. Capacity
3. MHA 2001
4. Conclusions
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1. Numbers
2. Capacity
3. MHA 2001
4. Conclusions
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Arrangement-focussed
view of justice
Realization-focussed
view of justice
They said the
MHA 2001
could not be
implemented…
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“Medicine is a social
science, and politics
nothing but
medicine at a larger
scale”
Rudolf Virchow
(1821-1902)