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Acute mania with decision-specific incapacity — DFSRH MCQ

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EasyMental Capacity ActAcute mania with decision-specific incapacityDFSRH

A 28-year-old woman in England is admitted with acute mania and is detained under the Mental Health Act 1983. She asks the sexual health team to remove her etonogestrel implant, which remains in date and is causing no adverse effects. She can describe the removal procedure, repeat that fertility may return immediately and communicate a consistent request. However, she believes the implant is transmitting her thoughts and that pregnancy is impossible because an external force has made her permanently sterile. Despite supported discussion, this delusional belief prevents her from considering the actual possibility and consequences of pregnancy after removal. The treating team expects her mania to improve substantially within several days. Which is the most appropriate next step?

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

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Correct answer: B — Defer removal, continue supported decision-making and reassess capacity when the mania improves.

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

The patient can understand, retain and communicate information, but these abilities do not alone establish capacity. Her mania is an impairment of mind or brain, and the causally related delusion prevents her from using or weighing the real possibility and consequences of pregnancy after implant removal. She therefore currently lacks capacity for this specific decision. The requested procedure is non-urgent: the implant is in date, is not causing harm and can safely remain temporarily. Because recovery of capacity is anticipated within days, the Mental Capacity Act approach is to defer the decision where practicable, continue support and reassess when she is better able to decide for herself. A is incorrect because failure of any one functional element, including use or weighing, can establish incapacity despite accurate recall and communication. B identifies a relevant boundary—the Mental Health Act does not itself authorise unrelated physical treatment—but does not justify performing removal without valid consent. D is inappropriate because capacity is time-specific and likely to recover; retention until expiry would bypass reassessment and impose a much longer decision than necessary. E is disproportionate because there is no urgent intervention, unresolved dispute or need for an immediate judicial determination. If she regains capacity and maintains her informed request, removal should then be offered even if clinicians regard her choice as unwise.

Reference: Service Standards on Obtaining Valid Consent in Sexual and Reproductive Health Services (2022) — https://www.fsrh.org/Common/Uploaded%20files/documents/service-standard-on-obtaining-valid-consent-2022.pdf Making decisions: a guide for people who work in health and social care (Current GOV.UK page checked 19 August 2026) — https://www.gov.uk/government/publications/health-and-social-care-workers-mental-capacity-act-decisions/making-decisions-about-your-health-welfare-or-finances