Decision making in mental health

Abstract

This thesis contains two papers. The first is a systematic review and meta-analysis examining how people with different mental health diagnoses score on four decision making capabilities measured by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Following systematic searches, data from 12 studies was used to perform eight meta-analyses. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). The results suggest that people with psychosis and mood problems may benefit from support to understand, appreciate and reason when approaching treatment decisions. Recommendations for future research include the importance of addressing methodological issues and exploring decision making capacity in people with common mental health problems like anxiety. Achieving this may contribute to guidance on where decision making support should be targeted in mental health practice as the MacCAT-T assesses four decision making capabilities that correspond with common clinical and legal standards of mental capacity.

The second empirical paper investigates how people who experience mental health problems can be supported to make decisions. The study outlined used a Delphi methodology to gain a consensus from a group of 23 experts, who have published writing in the area, on the essential components of and barriers to support with decision making in mental health services. Consensus was gained on 13 essential components of support with decision making, which were from four overarching themes. Consensus was also gained on three barriers, from one overarching theme, that are considered essential for services to address in order to implement this support. These findings may serve as useful guidance to all stakeholders involved in mental health services, including those who access services and professionals working in the area. It is hoped that the findings can contribute to the development of policy and best practice guidelines on supported decision making in mental health contexts.

Date of Award	Dec 2023
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	Donncha Hanna (Supervisor) & Gavin Davidson (Supervisor)