Hoarding disorder is a mental health condition characterised by persistent difficulty discarding possessions, excessive accumulation and significant disruption to the safe use of the home. The resulting disability often impairs daily functioning and contributes to severe health and fire risks. In rented accommodation, these hazards commonly bring hoarding to the attention of landlords and local authorities, leading to concerns about property damage, access for repairs and the safety of neighbouring residents. This article outlines the essential clinical features of hoarding disorder for psychiatrists and explains the key legal implications in the UK, including possession and injunction proceedings, disability discrimination under the Equality Act 2010, safeguarding duties and the relevance of capacity assessments. Its aim is to provide a clear educational foundation for clinicians involved in assessing individuals whose hoarding behaviour has led to legal or housing intervention.

The Mental Capacity Act 2005 was not designed to, and is not fit to, provide safeguards for assisted dying. The impairment requirement puts interpersonal pressure beyond the scope of the Act. The criteria included in the Act struggle to deal with the effects of affect and motivation on decision-making even for its intended purposes and within its intended scope. The use of the Act in the Terminally Ill Adults (End of Life) Bill presents an opportunity for reform.

This Editorial introduces the Special Issue on Advance Decision-Making, Law and Mental Health. This Special Issue presents a wide range of empirical studies and perspective pieces from Irish and international authors on advance healthcare directives and other reforms in mental health and capacity law. It aims to harness an interdisciplinary approach to enrich our understanding of new legislation and how it can shape mental health practice in a person-centred way, while also tackling thorny conceptual and practical challenges in this area.

According to the Mental Capacity Act 2005, P’s family are to be afforded a consultee role in a best interests decision. That is, they are to be involved in decisions but are not empowered to act as a substitute decision maker. However, in practice, healthcare professionals can struggle to set clear boundaries where families are insistent on more active treatment. The Best Interests in Renal Dialysis Study explored the making of best interests decisions in the context of adult kidney care in England. Interviewing healthcare professionals – both doctors and nurses – we found that it is not uncommon for the ‘path of least resistance’ to be pursued in best interests decisions where the family takes a strong position. Out of a fear of legal action and a desire to maintain a working relationship, healthcare professionals will sometimes compromise in providing care that they do not consider to be in P’s best interests to appease the family. This is seemingly at odds with the requirements of the Mental Capacity Act 2005, particularly where it goes as far as to prove harmful to P. Drawing on Margalit’s conception of rotten compromise, we argue that this form of rotten medical compromise undermines the law’s recognised P-centricity.

In this article, I explore how the mental health and mental capacity laws in England and Wales can be used for suicide prevention. I criticise the use of compulsion for persons diagnosed with a mental disorder who nonetheless retain decision-making capacity and argue for a greater reliance upon capacity as a distinguisher between autonomous decision-making about the end of life and the risk to life posed by symptoms of mental illness. The label of ‘suicide’ is also criticised as an outdated legal notion carrying pejorative meaning. Although focused on the law in England and Wales, the arguments apply much more broadly to all jurisdictions seeking to reconcile the demands of respect for life and respect for autonomy.

The ability to manage money is essential for independent functioning but highly sensitive to cognitive decline. Managing money involves more than deploying skills rationally; it is influenced by a range of emotional and psychosocial factors. There is relatively little knowledge about how older adults, families and care professionals working with older people navigate and experience potential challenges of declining mental capacity to manage money. This article draws on a UK-based study involving 13 older people and/or family members and 28 social sector professionals, and their experiences of supporting older people with cognitive decline to manage money, triangulated with public information resources from major national organisations across the health, care, consumer and charity sectors. It focuses on the emotive and personal nature of cognitive decline and money management. Declining mental capacity to manage money can strike at the core of people’s sense of who they are, leading to strong tensions and difficulties in discussing support. Support to manage money is often framed in discussions as ‘there if we need it’; this can be reassuring for people, but may be challenged if there are subsequent disagreements and changes in perspectives about the detail and timing of support. These nuances are not well reflected in public information resources, which largely emphasise administrative procedure. Financial organisations may lack empathy that declining mental capacity to manage money is extremely challenging. The article highlights a greater need for recognition of the emotional and psychosocial complexities presented by declining mental capacity to manage money in later life.

During the first half of the nineteenth century, Mid-Atlantic States expanded guardianship to include habitual drunkards. Legislators in Pennsylvania, New York, and New Jersey empowered courts to put habitual drunkards under guardianship, a legal status that stripped them of their rights to own property, enter into contracts, make wills, and, in some states, even vote. Amid the dramatic nineteenth-century expansion of male suffrage, the habitual drunkard signified a masculine failure of self-government that disqualified propertied men from the privileges of full citizenship. The struggle to define habitual drunkenness, detect the habitual drunkard, and put him under guardianship transformed the courtroom into an arena for contesting the thresholds of compulsion, policing respectable manhood, and drawing the borders of full citizenship in the nineteenth-century United States.

To make a valid will, a person should be able to understand the nature and consequences of doing so, the extent of their estate and the claims others may have on it. No disorder of mind should be present that would affect their testamentary decisions, and clinicians are therefore often asked to give an opinion on whether a person has testamentary capacity. This article discusses the legal issues involved, with reference to UK case law (in particular, the legal test of Banks v Goodfellow (1870)), and outlines the requirements of testamentary capacity assessment (including retrospective assessments), the clinician's responsibilities when requested by a solicitor to make an assessment of capacity (‘the golden rule’) and what they might expect if appearing in court to give expert witness regarding testamentary capacity. Fictitious case studies are presented illustrating certain points in testamentary capacity assessment.