Can persons with serious mental disorders make competent treatment decisions for themselves? Include the MacArthur Treatment Competency Study and Grisso and Appelbaum's research in the discussion.

Question

What will be an ideal response?

Answer 1

Answers may vary.The research for the MacCAT-T, conducted as part of a larger MacArthur Research Network on Mental Health and Law study on competencies, coercion, and risk assessment, focused on the capacities of individuals with severe mental disorders to make decisions and give informed consent about their own psychiatric treatment. Can persons with serious mental disorders make competent treatment decisions for themselves? Do their decision-making abilities differ from those of persons who do not suffer mental disorders?Researchers in the MacArthur Treatment Competence Study developed a series of structured interview measures to assess the four basic abilities-understanding information, applying information, thinking rationally, and expressing a choice-involved in legal competence.The interview has items that tap a person's ability to apply information to the question of whether he or she has a condition that could be effectively treated. According to Grisso and Applebaum, standardized interviews, using items of this type, were conducted with three groups of patients-those with schizophrenia, those with major depression, and those with heart disease-and with groups of people from the community who were not ill but were demographically matched to the patient groups. Only a minority of the persons in all the groups showed significant impairments in competent decision-making about various treatment options. However, the patients with schizophrenia and major depression tended to have a poorer understanding of treatment information and used less adequate reasoning in thinking about the consequences of treatment than did the heart patients or the members of the community sample. These impairments were more pronounced and consistent across different competence abilities for patients with schizophrenia than for patients with depression, and the more serious the symptoms of mental disorder (especially those involving disturbed thinking), the poorer the understanding.These results obviously have implications for social policies involving persons with mental disorders. First, contrary to popular impressions, the majority of patients suffering from severe disorders such as schizophrenia and major depression appear to be capable of competent decision-making about their treatment. On the other hand, a significant number of patients-particularly those with schizophrenia-show impairments in their decision-making abilities.