RE: #1 … there is an issue with no one at all being deemed incompetent, and I have witnessed this in my own family situation recently, as my family was involved in a legal dispute that hinged around the competence of a grandparent who had Alzheimers / Dementia. It was interesting to be in court watching a Geriatric Psychiatrist explain the evidence of my grandmother’s dementia, which made her vulnerable for “elder abuse” in which a relative was able to manipulate and extort money from her. The thing is, with most “mental health” diagnosis, for example something like Schizophrenia or Schizo-Affective, it seems to be a different story compared to something like Dementia. For one thing, part of the evidence was a numerous series of tests which were done to assess our Grandmother’s competence. In the case of Schizophrenia, there are no such tests. If you meet the criteria for that diagnosis you are immediately deemed incompetent. I am not saying there necessarily should be tests, I am just observing some of the differences. Another important factor in dementia was that you could see that it was caused by visible brain damage due to a stroke, as well as Demyelination of the nerves. When it comes to something like Schizophrenia or other mental health diagnosis, they are different than something like Dementia in that there is no biological evidence of the “disorder” itself, and no damage or changes to the brain aside from that which is caused by the medication given to apparently treat it. So really, there is no way to have any objective hard evidence of Schizophrenia, and it all relies on personal opinion, for a professional to say “that’s what it looks like to me” which of course is pretty shaky as it’s all based a subjective perception and interpretation. Another thing which I noticed recently, was I came across something about the history of the diagnosis of Schizophrenia, in that initially it was defined as Dementia Praecox, but that was dropped because it is not the same thing as Dementia, in that “intelligence and memory are unimpaired”. In my own personal experience, these issues around competency all seem to do with the right to refuse medical treatment… in all other areas of medicine there is the right to informed consent, but in the area of mental health, that right is taken away… in this circumstance receiving treatment automatically negates the right to refuse it, without any assessments of the persons competency necessary to take away that right. The reasoning here of course is “lack of insight” and by psychiatric reasoning, insight is basically synonymous with compliance. I was under a forced treatment order for a limited period of time but I was able to get out of that, and extricate myself from the psychiatric system and discontinue my medication on my own accord. While under that forced treatment order, aside from not being able to make the decisions in regards to refusal of treatment, there did not appear to be any other areas of my life where my personal agency and decision making were infringed upon. For example, for a period of time I had to put up with the psychiatrist trying to get me into some kind of a “group home” or “assisted living” where possibly my personal agency would be infringed upon further… but I never found myself in that position because they were not able to put me in that kind of living situation involuntarily. I was living with my Mother… and at that point all they could to was “suggest” a group home / assisted living, they could not force me into one of those places involuntarily… I wonder though, if in some situations it’s a different story? But again, my main point is a bit of a question, that when it comes to competency, it seems like it’s a very different situation in Geriatric Psychiatry and situations of Alzhemiers / Dementia compared the world of psychiatry that deals with psychotic disorders. Most people I have met who have at some time received diagnosis along that spectrum do not appear to me to have any major cognitive impairment.. or at least, the experience of psychosis itself does not seem to necessarily go hand in hand with cognitive impairment, I would say that the majority of people who have received that diagnosis have just as much decision making capacity as any other person.. and the claim of “lack of insight” or being deemed incompetent seems to be strictly a form of control to enforce medical compliance. But doing away with this altogether might not work out very well because Geriatric Psychiatry appears to be a much different situation, in which people living with dementia may really have cognitive impairments which could put them in a vulnerable position.