• A patient demonstrates mental competency if they can show appropriate understanding, insight and judgement regarding the decision they make and the immediate consequences that may result
  • A person may be competent to make decisions in one sphere of life but not another
  • It is imperative to identify any organic or functional illness that may impair a patient's competence
  • These conditions include patient's that are mentally ill, intellectual disabled or with altered mental state from drugs/alcohol, head injury, metabolic abnormalities or infection
  • It is generally accepted that patients with an acute psychiatric illness who wish to actively harm themselves or others are considered incompetent and require detention
  • Age of itself is not a determining factor of competence - It may vary according to what choices they are offered e.g. a 10 year old may be able to agree to have a plaster case applied but not to major elective surgery
  • Remember that not all incompetent patient are at imminent risk to themselves or others
  • Similarly not all patients who wish to harm themselves or others are incompetent - such patients may need referral to law-enforcement agencies

see Restraint of patients
see Discharge against advice
see Consent issues in psychiatric patients


Disclaimer: Note: The information described here relates solely to operational matters in the Emergency Department.  Every effort has been made to verify the accuracy of the content. However, neither the author or the hospital will take responsibility for errors resulting from its use.  Please refer to your own departmental guidelines and verify all clinical decisions with a reliable source.  

Date Last Reviewed: 05/08/2004