DETERMINING COMPETENCY

• 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