The Use of Mental Capacity and Mental Health Laws in the Care of People Living With Dementia in Residential and Hospital Settings: A Systematic Review of the Literature

TL;DR

This review explores how mental capacity and mental health laws are applied to people with dementia in care settings and highlights gaps between legal ideals and real-world practice.

Contribution

The study systematically reviews how dementia-related legal decisions are made and experienced, focusing on the gap between UNCRPD principles and practice.

Findings

Professionals' understanding of mental health laws varies significantly.

Care settings and dementia severity influence decision-making processes.

People with dementia are often excluded from legal decision-making.

Abstract

The UN Convention on the Rights of Persons with Disabilities (UNCRPD) has implications for the use of law with people living with dementia. This systematic review identifies how decisions to deprive people living with dementia of their liberty, using domestic mental capacity and mental health laws, are understood and made by professionals, and are experienced by people living with dementia and their carers. Database searches of Scopus, IBSS, CINAHL, PubMed, HMIC, and Social Policy and Practice were conducted to identify relevant academic and grey literature, with final searches in July 2024. No geographical or time scale restrictions were applied. Studies not written in English were excluded. Study quality was assessed using the Mixed Methods Appraisal Tool and thematic synthesis was used to organise data. The study was funded by Avon and Wiltshire Mental Health Partnership (grant number SP1200) and is registered on Prospero (CRD42023483046). Eleven studies were selected for review. Six papers were qualitative, three were quantitative and two employed mixed methods. Eight studies were based within the UK and all studies were conducted in Europe. Key themes were (1). Levels of legal understanding amongst stakeholder groups. (2). The influence of professional background on decision-making in dementia detention cases. (3). The impact of the severity of dementia and dementia diagnosis on decision-making. (4). The impact of care setting on decision-making. (5). The experiences of carers during decision-making. (6). The exclusion of people living with dementia during decision-making. Limitations are that not enough studies were identified to provide a meta-synthesis, non-English texts were excluded and that we did not specifically search for articles relating to guardianship laws. Our study identified significant gaps between the ideals of the UNCRPD and practice in health and social care settings.

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