Mental capacity and suicide: “He has mental capacity” is not a reason for clinicians to stand back and do nothing. We need to protect life.

Written: August 6, 2020

Elaine tried desperately to get help for her son during the final days of his life. She felt he was too unwell to ask for help himself. His mental health had deteriorated and he was hearing voices. He was having suicidal thoughts and she was worried that he was going to end his life. He was under a community psychiatric service for people who experience psychosis.

When she asked the mental health crisis team to contact him over that final weekend, they told her that her son needed to phone them. They had often said that they wanted him to take more responsibility. Their usual approach was to tell Elaine: “He is welcome to call us”.  He never did, and tragically he took his own life on the Monday morning, while Elaine was downstairs on the phone trying once again to get help for him.

At the inquest into his death, the coroner commented that he had “mental capacity”. In her summing up, she said that he had the mental capacity to make decisions. The coroner made that statement based on psychiatrists’ evidence at inquest. They emphasised during and after the inquest that James “frequently” had capacity.  

In fact, none of us know whether he had the capacity to make decisions or not, in the period leading up to his death. No one from the mental health teams had spoken to him for several days.  A person’s mental capacity to make decisions can change from hour to hour. High levels of distress or mental illness are just two of the factors that can affect it. And James had a history of psychosis.

So why is it so important for psychiatric professionals to emphasise that someone has mental capacity? Too often, it seems to be about “responsibility”. If the person is assessed as having “mental capacity”, then it appears that the mental health team are able to say that they do not have a responsibility to intervene. The mental health crisis team didn’t contact James, despite his mum’s pleas. But “he had mental capacity, so they didn’t have to” – that seems to be the sub-text from the evidence provided at inquest .

But James’ mum had described James’ deteriorating mental health to the crisis team. He had completely isolated himself, was hearing voices and had a history of psychosis and she explicitly said that she was frightened that he was going to kill himself.  Armed with that kind of information, professionals surely have a duty to take active steps to contact, assess and support the person.

When professionals refer to “mental capacity” as a reason to stand back and place responsibility on the person who is in crisis, I would remind them of article 2 of the Human Rights Act: the Right To Life. It takes precedence.

It is as if the “right to life” is being usurped by the “right to take your own life” when someone is in mental health crisis. Surely the balance is all wrong. If you are in mental health crisis, it is a time when you are least likely to be able to think clearly and rationally, or to be able to “weigh information”. Despite this, the system appears to respect your right to take your own life.

Surely there is a duty to do everything we can to help the person to survive. We should protect life, whether or not someone is assessed as having “mental capacity” – and whether or not they are detainable under the Mental Health Act, which is a different piece of legislation.

We cannot even be fully confident that all professionals are assessing mental capacity accurately. I have described in a previous article how a paramedic and a policeman made entirely different assessments of my mental capacity, on a night when I intended to end my life. I believed I had received messages to end my life on that date.  Astonishingly, one of the professionals concluded that I had mental capacity. He said that I could understand and retain information. Fortunately the other professional quickly intervened and detained me. My ability to weigh information was clearly being impacted by the “messages” I had received. (Reference: Why do mental health professionals tell patients “It’s your decision to end your life”? https://www.savinglives.blog/uncategorized/suicide-why-do-mental-health-professionals-tell-patients-its-your-decision/ )

It is this ability to “weigh up information” which I think professionals may be getting wrong quite frequently. Depression often affects our ability to weigh information. We see life through its distorted lens. If depression makes you feel that things will never improve, that there is no hope and that you have no worth, then this is affecting your ability to weigh information and make decisions. And yet frequently, someone will explain all that and be assessed as being capacitous and able to make the decision to end their life. We know this from people who we see at our Suicide Crisis Centre, who come to us from mental health services. I often need to express concerns to our local mental health services about individual clients, because depression appears to be impacting on their thought processes. 

We have to redress the balance to place more of the responsibility on us, as professionals. It is our job to protect life.  I run an independent Suicide Crisis Centre where we focus on doing everything we can to help our clients to survive. We actively intervene, whether or not we think someone has mental capacity.  We know that the person is probably about to make a decision that they would not make if they were not highly distressed, or mentally unwell. Therefore, protect life – always.

Elaine kindly gave her permission for this article about James, who was known to his family as Jay. Elaine added: “Jay didn’t want to die. He wanted help. He was crying out for help.” Elaine found out about our charity after Jay died. We attended his inquest in 2019, to support his family. This article draws on evidence from the inquest. Our thoughts are with Jay’s family as they continue to fight for justice for Jay.

For information about the Suicide Crisis Centre, which provides face to face support: http://www.suicidecrisis.co.uk Other sources of help include telephone support from The Samaritans on 116123 and the NHS 111 service (just call 111). NHS 111 can find you help in your own area, including urgent and emergency face to face crisis help. The national Mind Helpline is also available on weekdays on 0300 123 3393 and they can direct you to sources of help.

Joy Hibbins is the author of the book “Suicide Prevention Techniques: How A Suicide Crisis Service Saves Lives”: http://www.suicidecrisis.co.uk/suicide-prevention-techniques/

 Copyright © Saving Lives Blog

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