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 (MHEL) 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. A core area of research interest is mental capacity.

What is mental capacity?

Mental Capacity, or decision-making capacity, 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).

Why is this important?

Lawyers, medical ethicists and clinicians 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 deciding matters such as treatment, finances or research participation? How can it be assessed in youth? Or for decisions that may have to be made some time in the future (advance decisions)? Or for decisions relating to life and death?

How can we develop fairer and more accurate ways to assess the loss of decision-making capacity, and also support individuals in their decision making.

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 disorders 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.

Research-led teaching

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.

MSc in Mental Health, Ethics and Law (Centre for Medical Law and Ethics)

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. Based in the law school, it equips students to become leaders in healthcare, mental health law or policy.

Maudsley Learning – Masterclasses in Complex Capacity Assessment

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. A research-based guide to capacity assessment for clinicians and social care professionals in maintained here.

Projects

Complex Life and Death Decisions Group

The Complex Life and Death Decisions group (CLADD) is an ongoing project that addresses issues such as assisted dying, suicide and treatment refusal. These issues form an interconnected ‘wicked problem’. Wicked problems are hard because they are complex conceptually and empirically, but also because they can involve conflicting values and divergent emotions. CLADD is a King’s based group with expertise in psychiatry, palliative care, bioethics, public policy and law. Members of the group lead research in life and death decision-making (particularly in relation to mental health conditions and palliative care), contribute to policy development, professional guidelines and law reform, and have appeared in leading court cases.

The Mental Health and Justice project

Mental Health & Justice was a 5-year Wellcome Trust-funded multi-disciplinary research initiative led by Gareth Owen, which addressed 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 was 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. Do visit the project archive which includes a video about the whole project as well as other resources.”