Court of protection rules on capacity in complex mental health case

Court of Protection rules on capacity in complex mental health case

The Court of Protection has delivered a significant ruling in a case involving a young woman, CC, who was the subject of an application by the Barnet, Enfield and Haringey Mental Health NHS Trust. The case revolved around the capacity of CC, a 21-year-old woman with autism spectrum disorder (ASD) and anorexia nervosa, to make decisions about her medical treatment.

Mr Justice Hayden presided over the case, which involved complex issues surrounding CC's ability to make informed decisions regarding her nutrition and medical treatment. The Trust sought declarations on CC's capacity to conduct proceedings and make decisions concerning her medication and treatment.

CC, described as an effervescent and talented young woman, has struggled with the strictures of her ultra-orthodox Jewish community due to her ASD. Despite her intellectual abilities and warmth, her condition has led to significant challenges, particularly in relation to her eating disorder.

Dr Matthew Cahill, a consultant psychiatrist specialising in eating disorders, was instructed to provide an expert opinion. He concluded that CC lacked the capacity to make decisions about her treatment due to her overwhelming fear of weight gain and her inability to weigh the relevant information.

The court considered various treatment proposals, including admission under the Mental Health Act and the use of Esketamine, a psychedelic drug, for treatment-resistant depression. However, Dr Cahill and the court agreed that CC's capacity was significantly impaired by her ASD, which affected her ability to weigh information and make decisions.

Mr Justice Hayden emphasised the importance of the legal framework under the Mental Capacity Act, which requires a decision-specific approach to capacity. He noted that while CC had insight into her condition, her ASD and eating disorder prevented her from effectively weighing the information necessary for decision-making.

The court ultimately ruled that CC lacked the capacity to make decisions about her treatment and to conduct proceedings. The judgment highlighted the need for a nuanced approach to capacity assessments in cases involving complex mental health issues.

Mr Justice Hayden expressed respect for CC and her family, acknowledging the challenges they face. He also praised the dedication of CC's medical team, including Nurse A, who provided crucial support.

The court's decision underscores the importance of addressing the impact of ASD in treatment plans and ensuring that any future interventions, such as Esketamine, are given the best possible chance of success.

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For more information on medical negligence and mental health law, see BeCivil's guide to Medical Negligence.

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