Dr Saal Seneviratne Expert Witness in Psychiatry

Impact on psychiatrists in intellectual disability of
Court of Protection orders for section 49 (Mental Capacity Act) reports: online survey

BJPsych 2023 Jun;47(3):127-132.

Suraj Perera, Nathalie Leyland, Jonathan Coshever

Section 49 of the Mental Capacity Act 2005 lets the Court of Protection in England and Wales demand reports from NHS trusts and local authorities about a person involved in proceedings. This has proven challenging for trusts, requiring their psychiatrists to prepare medico-legal reports, potentially overstretching resources and expertise. This burden has sparked formal concern in court and government, including a call for a more manageable approach.

The study surveys the experience of psychiatrists in intellectual disability working with section 49 reports in the UK. The survey was developed by the authors and implemented via Microsoft Forms, gathering information on respondents’ work intensity, support, and impact of report completion on their practice and well-being. The survey was distributed to consultant and career grade psychiatrists across England and Wales.

A total of 104 responses were received. Of these, 65.4% had been ordered to undertake a section 49 report between January 2017 and June 2020. On average, respondents completed 2.44 reports, mainly focusing on care and support needs and accommodation and residence, with mental health being the subject of only 11.3% of the reports.

Regarding the time needed for report completion, 30.8% of the reports took 10-20 hours and 21.8% required more than 20 hours. A request for an extension was made for 78.2% of the reports and was granted in 66.3% of these cases.

Regarding support, 50% of respondents who had completed reports had access to a trust solicitor, and 29.4% were aware of their trust’s standard operating procedure for managing section 49 reports. However, 69.1% stated they had ‘no support’ in providing the report.

Confidence in report writing was low among first-time report writers, and over half were asked to provide an opinion outside their subjective expertise. This resulted in high stress levels, with 85.3% reporting some or significant stress, and 77.9% stating it had impacted their routine clinical work.

The study calls for better regulation of the process and more training and support for clinicians writing section 49 reports.