‘Mentally Incapacitated Adults and Decision Making’: implications of the Law Commission consultation paper for old age psychiatrists

incapacity is with patients with dementia. Dementia is predominantly a disorder of old age, probably affecting over half a million people in the UK, and it inevitably affects decision-making capacity. The 1983 Mental Health Act does not appear to have been framed with particular consideration for this group and it is vital that any new laws pay special attention to people with dementia. Currently only a minority of people with dementia come under the care of psychiatrists, but psy chiatrists are often involved where psychiatric diagnosis, investigation and management are called for and this involvement may increase dramatically if new drug treatments become available. Most property and personal decision-making for this group is currently informal. In respect of psychiatric treatment, decisions are usually made by a psychiatrist. These decisions are, in the best practice, made in discussion with the patient, rela tives and multidisciplinary team. Relatively minor decisions or urgent decisions are made by the psychiatrist in consultation with nurses and (where appropriate) the patient. If compulsion is necessary, the existing powers of the Mental Health Act are invoked. Psychiatrists are sometimes involved in the proceedings of the Court of Protection and in judging a patient's competence to make a Power of