Mental Health, Ethics & Law Research Group

The interface between the law, ethics and mental health raises fundamental questions at a theoretical level and in clinical and legal practice. Each discipline approaches these questions from its own perspective but, increasingly, connections arise. This can lead to new insights and important reformulations but also to misunderstandings and conflict. The Mental Health, Ethics and Law Research Group investigates the clinical, ethical, legal and policy thinking behind key dilemmas and uses interdisciplinary research strategies to help resolve them and generate new understandings and ideas. It engages directly with the experience of ill-health both through its links to NHS services and service user involvement.

Current research projects which the group lead on include the Wellcome-funded Mental Health and Justice project and investigations of Age and Cognitive Impairment in resource allocation during the Covid-19 pandemic. Past projects have included Wellcome and NIHR funded studies of decision-making capacity in a variety of contexts.

The MHEL Research Group provides teaching on King’s postgraduate MSc in Mental Health, Ethics and Law, on its medical student MBBS programme and on several teaching programmes offered by the Maudsley.

The Mental Health and Justice project

Mental Health & Justice is a Wellcome Trust-funded multi-disciplinary research initiative, which addresses a cluster of public policy challenges that arise where mental health and mental healthcare interact with human rights principles. The fundamental aim of the project is to develop clinical, legal, and policy strategies for jointly satisfying two fundamental imperatives: to respect their agency and autonomy, and to protect people in contexts where they might be vulnerable. Visit the project website for more information.

What is decision making capacity (DMC)?

DMC refers to a person’s ability to make a decision for oneself. In England and Wales, this concept is defined and implemented through the Mental Capacity Act (2005). A person is always assumed to be able to make an autonomous decision, unless it is explicitly evidenced otherwise by way of the criteria set out in law.

Why is this important?

Lawyers and medical ethicists are increasingly relying upon the concept of decision making capacity. All of us at times can lose this capacity (e.g. when intoxicated 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 support individuals in accessing and developing such capacities at times when these are under threat.

Human rights implications

Human rights aim to be universal, inviolable and apply to all people. Increasingly, human rights law is extending to healthcare where rights such as the right to life, health, liberty and personal autonomy need to be interpreted in contexts of mental illness or cognitive impairment. Human rights are 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 and capacity expertise into policy debates.

What we study

The MHJ project comprises six parallel workstreams across multiple sites. The researchers based at the IoPPN work primarily on issues around advance directives, metacognition and contested capacity assessments. For our current projects, we are particularly interested in the following questions:

1. In what ways might people with bipolar benefit from a specific type of advance directive called a ‘Ulysses directive’?
2. How might services facilitate the use of advance directives?
3. What is the relationship between decision making capacity and cognitive constructs, such as metacognition and insight?
4. How might situational or interpersonal factors affect decision making abilities?
5. In legal cases, what are the most complex debates surrounding whether or not someone has decision making capacity?
6. What can be done to support clinicians to assess mental capacity better?

Previous projects

The group has conducted various other projects relevant to decision making capacity. These include, but are not limited to:

1. Studies into the lived experience (“phenomenology”) of decision-making in severe depression, mania, schizophrenia and frontal brain injury.
2. Studies quantifying consent to research or treatment in psychiatric and medical inpatient settings.
3. Studies informing policy makers of specific law reform options and the international evidence and arguments for or against them.

Research-led teaching

MSc in Mental Health, Ethics and Law

Programme director: Dr Jillian Craigie (Senior Lecturer in Medical Ethics, Centre for Medical Ethics and Law, KCL)

This postgraduate taught course with core teaching from Gareth Owen (psychiatry), Jillian Craigie (ethics), and Alex Ruck Keene (law) provides an integrated, strongly interdisciplinary, education in mental health, ethics and law. It will equip students to become leaders in healthcare, mental health law or policy.

Maudsley Learning – MHJ Masterclasses in Mental Capacity

These are an intensive, research–informed, one-day interactive workshops that provides advanced training for practitioners who apply the Mental Capacity Act in their practice. Teachers include Alex Ruck Keene and Gareth Owen.