Civil forensic psychiatry — structured clinical viva

Frame. This is civil forensic work: multiple decisions (will; complex investments; possible substitute decision-making). Vascular cognitive impairment raises risk but does not equal global incapacity. Assess each decision against the relevant legal principles for the jurisdiction — name principles, do not invent Act sections.^[1][5]

Testamentary. Apply Banks v Goodfellow teaching principles with teach-back on will nature/effect, property in broad terms, natural objects of bounty, and absence of disordered motivation poisoning the gift. Document MSE and collateral.^[2][3]

Financial. Domain-map: everyday transactions, bills, assets, gifts, investments, scam vulnerability. Complex portfolio management may fail while simple bill-paying remains — partial capacity is common and important.^[3][4]

Guardianship interface. Opine domain-by-domain with residual abilities and less-restrictive supports; avoid a single pejorative “incompetent” stamp. Local pathways for financial management orders are jurisdiction-specific.^[5]

Appelbaum–Grisso / MacCAT-T. Understanding, appreciation, reasoning, expressing a choice is the functional scaffold for many civil decisions; MacCAT-T is most validated for treatment decisions as an adjunct, not a court substitute.^[6][7]

Dual role. If treating doctor, disclose conflict: therapeutic alliance vs expert neutrality. Prefer independent expert when contested; if unavoidable, state dual role and limits clearly.^[8][9]

Report. Questions separated; sources; role; history; MSE; criterion-linked opinions; limitations; no invented statutes.^[8][9]