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Capacity in Psychosis — MRCPsych Paper B MCQ

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HardMental Health LawCapacity in PsychosisMRCPsych Paper B

A 40-year-old man in England with schizophrenia is detained under section 3 of the Mental Health Act 1983 during a psychotic relapse. He is asked whether he agrees to take oral antipsychotic medication. After all practicable support has been provided, he can describe and retain the purpose, likely benefits, material risks and alternatives to treatment. However, because he has a fixed belief that the tablets are poison, he is unable to consider that this information applies to him or to compare the risks of treatment with those of remaining untreated. Which conclusion is most accurate under the Mental Capacity Act 2005?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — He lacks capacity for this decision because the delusion prevents him from using or weighing relevant information.

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

B is correct. Capacity is presumed, decision- and time-specific. The ability to understand and retain information is not sufficient: the person must also be able to use or weigh the salient information relevant to the particular decision. Here, the fixed delusion prevents him from applying treatment information to himself and comparing the consequences of accepting or refusing medication. This establishes the required causal link between mental impairment and functional inability. A is therefore incorrect. C is incorrect because capacity should be assessed during psychosis, with reassessment if circumstances change. D is incorrect because detention does not itself exclude application of MCA capacity principles. E is incorrect because schizophrenia alone does not establish incapacity, nor does incapacity for one decision determine capacity for others.

Reference: NICE, Decision-making and mental capacity (NG108), recommendations on assessment of mental capacity, 2018. https://www.nice.org.uk/guidance/NG108/chapter/recommendations