Capacity to consent in dementia and the additional costs of implementing the Bournewood Judgement in geriatric psychiatry

Traditionally, patients with dementia, who do not dissent, have been informally admitted to psychiatric wards in the UK. The recent Court of Appeal judgement (Bournewood Judgement) suggested that patients lacking the capacity to consent to inpatient psychiatric care should be admitted under the Mental Health Act irrespective of absence of dissent. On appeal, this judgement was overturned by the House of Lords. The marginal and new additional costs of implementing the Bournewood Judgement in clinical practice were estimated to illustrate the resource implications of legislative changes in the wider context of capacity to consent in dementia. They were estimated for one geriatric psychiatry unit and national costs were also estimated by extrapolation. The additional annual cost of implementing the Bournewood Judgement in our unit with a catchment area of 23,000 elderly was estimated in the range of pound 6,670 to pound 13,340. The extrapolated national costs using two techniques were in the range of pound 8,695,000 to pound 17,416,000 and pound 2,555,000 to pound 5,110,000, respectively. The potential implications of the additional costs due to legislative changes on the already precarious geriatric psychiatry services is discussed in the context of capacity to consent in dementia.