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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 policymakers in the UK and with researchers internationally. 

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