The RECAPACITA PROJECT: comparative study of the clinical, neuropsychological, and functional profile of people with severe mental disorder and partial and total capacity modification

TL;DR

This study compares the mental and functional abilities of people with severe mental disorders who have partial or total legal capacity modifications.

Contribution

The study provides a detailed comparison of clinical and functional profiles between partial and total capacity modification groups in Spain.

Findings

Individuals with total capacity modification showed greater clinical impairment and lower cognitive functioning.

Those with total capacity modification had worse social functioning and lower mental capacity scores.

Partial capacity modification was associated with fewer psychiatric comorbidities compared to total modification.

Abstract

Evaluating the decision-making capacity of individuals with Severe Mental Disorder (SMD) is essential for compliance with the 2006 Convention on the Rights of People with Disabilities. In Spain, capacity was historically determined through judicial procedures, resulting in partial or total capacity modification (CM). The abolition of this procedure in 2021 has left a gap in addressing the needs of this population, creating challenges under the new legal framework.

The RECAPACITA project studied the clinical, neuropsychological, and functional profiles of individuals with SMD and CM, focusing on differences between partial (pCM) and total (tCM) modifications.

A cross-sectional study was conducted with 77 adult patients with SMD and CM (47 tCM, 30 pCM) from the Parc Sanitari Sant Joan de Déu mental health network (Spain). Sociodemographic, clinical, functional, and neuropsychological data were collected, along with an independent assessment of mental capacity.

Around 87% of sample had a schizophrenia spectrum disorder; pCM patients presented more substance-related and personality disorders as a secondary diagnosis. While no statistically significant differences were observed between groups, clinically, tCM group presents greater clinical alteration, lower insight, sustained attention, coding capacity, processing speed and resistance to interference compared to pCM group. tCM group had worse social functioning, and lower scores in reasoning and appreciation when assessing mental capacity.

Individuals with tCM show greater clinical impairment and higher support needs compared to those with pCM. With the practical and legal abolition of tCM, it is essential to ensure that these individuals’ persistent challenges are adequately addressed, as their needs remain significant despite the disappearance of this legal category.