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Serious Mental Illness

Serious Mental Illness

by Sharon Bronner

Competency is a legal term and is decided by the court of law (Schouten & Brendel, 2004).

Capacity suggests the ability to comprehend the problem and to make a decision. Capacity is an assessment of a psychiatric/medical provider.

Applebaum and Grisso (1988) outlined four criteria used to determine capacity to consent to treatment:

  1. Patient expression of a preference.
  2. Ability to understand the illness, the prognosis with and without treatment, and the risks and benefits of the treatment (accurate understanding).
  3. An appreciation of the significance of the facts (significance of the facts).
  4. Ability to use the information in a rational way to reach a decision in a logical manner (rationality of the thought processes).

Incompetence can be caused by intense pain, depression, delirium, dementia, and psychosis (Schouten & Brendel, 2004).

Collaboration with the team and communication is a key component to providing quality of care for the serious mental illness population.

Sharon Bronner, DNP, MSN, APRN, GNP, BC Hct


  • Applebaum, P.S., & Grisso, T. (1988). Assessing patient’s capacities to consent to treatment. New England Journal of Medicine, 319(25), 1635-1638.
  • Schouten, R., & Brendel, R.W. (2004). Legal aspects of consultation. In T.A. Stern, G.L. Fricchione, H.N.H. Cassem, M.S. Jellinek, & J.F. Rosenbaum (Eds.), Massachusetts General Hospital handbook of general hospital psychiatry (5th ed.) (p. 356). Philadelphia, PA: Mosby.