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Mental health, ethics and law

Interdisciplinary research

Deciding for oneself

Law and medical ethics increasingly make use of the concept of ‘decision-making capacity’ - the ability to make a decision for oneself about, for example, treatment. All of us at times can lose this capacity (e.g. when drunk or even in the height of passion) and all of us have spent our childhoods developing it. But how do conditions such as bipolar affective disorder, schizophrenia, depression, brain injury, and dementia affect our processes of decision-making? In the field of mental health, how can we develop fairer and more accurate ways to assess the loss of decision-making capacity, but also to support individuals in accessing and developing such capacities at times when these are under threat. 
The kind of questions we address include:
  • What characterises the lived experience (“phenomenology”) of decision-making in severe depression?
  • How common is the loss of one’s ability to decide for oneself about treatment or research participation in both psychiatric and medical settings?
  • What factors are typically associated with losing and regaining the capacity to decide for oneself?
We are interested in using this understanding to improve the way supportive decision-making and substitute decision-making is approached in health and social care and to explore whether policy/statute is a good fit or could be better adapted.
Selected publications:
1. Temporal inabilities and decision-making capacity in depression/ Owen, Gareth; Freyenhagen, Fabian; Hotopf, Matthew; Martin, Wayne,                         
 In: Phenomenology & the Cognitive Sciences, Vol. 14, No. 1, 03.2015, pp. 163-182.
2. Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study /Owen, Gareth; Richardson, G; David, A S; Szmukler, G; Hayward, P; Hotopf, M.
In: BMJ (International Edition), Vol. 337, No. 7660, 2008
3. Mental capacity, diagnosis and insight in psychiatric in-patients: a cross-sectional study. / Owen, Gareth; David, A. S.; Richardson, G.; Szmukler, G.; Hayward, P.; Hotopf, M.
In: Psychological Medicine, Vol. 39, No. 8, 08.2009, p. 1389 - 1398.

Human rights and health

Human rights aim to be universal, ‘inalienable’ and apply to all people. Increasingly, human rights law is extending to healthcare where rights such as the right to life, health and liberty need to be interpreted in contexts of mental illness. Human rights is also moving towards a more ‘active’ model, by creating a framework supporting those with disabilities to become decision-makers, guiding their own lives and treatment. Our research aims to inform and develop human rights thinking by bringing mental health expertise into academic and policy debates. 
Selected publications:
1. Deprivation of Liberty in Healthcare : UK Supreme Court judgement has changed the rules. / Cairns, Ruth; Hotopf, Matthew; Owen, Gareth.
In: British medical journal, Vol. 348, g3390, 21.05.2014
2.'Rabone' and four unresolved problems in mental health law. / Szmukler, George; Richardson, Genevra; Owen, Gareth
In: The Psychiatrist, Vol. 37, No. 9, N/A, 09.2013, p. 297-301
3. Fluctuating capacity and advance decision-making in Bipolar Affective Disorder. / Gergel, Tania; Owen, Gareth.
In: International Journal of Law and Psychiatry, 2015.
Our research has received funding from the Wellcome Trust, the NIHR, the Department of Health and the AHRC. 
Inquiries regarding PhD/MD(Res) studies are welcomed.
Centre of Medical Ethics and Law
Professor Anthony David
Professor George Szmukler
Dr Paul Moran
Professor Diana Rose
University of Essex:
Professor Wayne Martin
Dr Fabian Freyenhagen
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