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General hospital psychiatry


The department has an active interest in questions around substitute decision-making and supportive decision-making in healthcare. Many of these questions mark a meeting point between health and justice and our approach to them is interdisciplinary.

The kinds of questions we have addressed include:

•    How common is the ability to decide for oneself in psychiatric and medical settings?
•    What factors associate with losing the ability to decide for oneself and regaining it?
•    How many people able to decide for themselves about treatment receive treatment involuntarily?
•    How many people not able to decide for themselves about treatment are safeguarded and do current safeguards work?

We also have an interest in studying the phenomenology of decision-making in different groups with mental disorder and building models of supportive decision-making and substitute decision-making that are informed by these studies.

The research is funded by the Wellcome Trust, the NIHR, the Department of Health and the AHRC. Our approach includes epidemiological and in-depth interview methods in clinical settings. We have collaborations with the school of law, with other departments within the Institute of Psychiatry, Psychology & Neuroscience and with an AHRC funded project on Autonomy based in the department of philosophy at the University of Essex. We maintain close links with policy-makers in the UK and with researchers internationally.


Professor Matthew Hotopf

Dr Gareth Owen Tel: 02078485479

Selected publications:

•    The Prevalence and Associations of Mental Incapacity in Medical In-Patients. Raymont, V. Bingley, W. Buchanan, A. David, A. Hayward, P. Wessely, S. Hotopf, M. Lancet (2004) 364: 1421-27
•    Assessment of mental capacity in individuals with mental illness: an inter-rater reliability study. Cairns, R. Maddock, C. Buchanan, A. David, A.S. Hayward, P. Richardson, G. Szmukler, G. Hotopf, M. Br J Psychiatry (2005) 187: 372-378
•    Mental Capacity in Psychiatric Patients: A Systematic review Okai, D. A. Owen, G.S. McGuire, H. Singh, S.P. Churchill, R. Hotopf, M. Br J Psychiatry (2007) 191: 291-297.
•    Mental capacity to make treatment decisions in patients admitted to a psychiatric hospital – cross sectional study. Owen, G.S. Richardson, G. David, A.S. Szmukler, G. Hayward, P. Hotopf, M. Br Med J (2008) 337 (301): a448.
•    Mental Capacity and Judgmental Autonomy: An Interdisciplinary Challenge. Owen, G.S. Freyenhagen, F. Hayward, P. Richardson, G. Hotopf, M. Inquiry (2009) 52: 79-107.
•    Mental capacity and psychiatric inpatients: some implications for the new mental health law. Owen, G.S. Szmukler, S. Richardson, G. David, A.S. Hayward, P. Rucker, J. Harding, D. Hotopf, M. Br J Psychiatry (2009) 195: 257-263.
•    Retrospective views of psychiatric in-patients regaining mental capacity. Owen, G.S, Richardson, G., David, A. Szmukler, G., Hayward, P., Hotopf, M.. British Journal of Psychiatry (2009). 195: 403-407
•    Mental capacity, diagnosis, and insight in psychiatric inpatients: a cross sectional study. Owen, G.S. Richardson, G. David, A.S. Szmukler, G. Hayward, P. Hotopf, M. Psychological Medicine (2009) 39:1389-98
•    Regaining capacity following inpatient treatment : a clinico-ethical study. Owen, G.S. Chis Ster, I., David, A.S., Szmukler, G., Richardson, G., Hotopf, M. 2009. Psychological Medicine (2010) 29:1-10
•    Comparing Judgments about Deprivation of Liberty by Lawyers, Psychiatrists, Best Interests Assessors and Independent Mental Capacity Advocates. Cairns, R., Brown, P. Grant-Peterkin, H. Owen,G.S., Richardson, G., Szmukler, G. Hotopf. H. The Psychiatrist (2011) 35: 344-349.
•    Senior Doctors’ Opinions of Rational Suicide, Stephen Ginn, Annabel Price, Lauren Rayner, Gareth S. Owen, Richard D. Hayes, Matthew Hotopf, William Lee. Journal Medical Ethics (2011) 37:723-6

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