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Background: Mental capacity based mental health legislation has been proposed, but its potential impact on practice has not been described. Aims: To describe the extent to which mental capacity based law might change prescriptions of electroconvulsive therapy (ECT) in England and Wales. Method: A qualitative study using focus groups and semi-structured interviews of psychiatrists, was followed by a cross sectional study of 186 consultant psychiatrists. Results: Psychiatrists were divided in their management of detained but apparently competent patients refusing ECT. From the cross sectional survey, 15.9% reported having prescribed ECT in such patients, but some expressed views that the treatment was not acceptable under these circumstances. Conclusions: Mental capacity based legislation could limit the use of compulsory treatment to some individuals refusing treatment. However, it might equally lead to psychiatrists redefining their operational definitions of mental capacity. Declaration of interest: This study was funded by the Department of Health. © Shadowfax Publishing and Informa UK Ltd.

Original publication




Journal article


Journal of Mental Health

Publication Date





315 - 325