Clinicians need to be vigilant about whether the court’s intervention is required because of a dispute or specific legal requirement in relation to their patient. Circumstances may arise when it is necessary to obtain authority from a court regarding the lawfulness of a treatment (either to be given or withdrawn) when a patient refuses, lacks capacity or there is a difference of opinion regarding best interests. In other cases, a judgment from the court may protect a clinician from claims that they have acted unlawfully. Of course, the courts are also there to safeguard the welfare of the patient. We discuss the role of the First-Tier Tribunal (Mental Health) and that of decision-making capacity of patients to participate in tribunal proceedings. We then explain the Court of Protection and its powers, and the pathways for application to the court, as well as the evidence that a clinician may be required to provide. We consider common health and welfare cases that the Court of Protection may be asked to decide on and then discuss the role of the inherent jurisdiction of the High Court in protecting the vulnerable but capacitous.

Discharge planning of older people with dementia to a domestic or care home setting can present difficult practical, legal and ethical dilemmas to the hospital clinician. There may be a different and challenging profile of risks whichever strategy is pursued, but undoubtedly the issue of where someone lives or the care they receive has profound personal importance. Decision-making around these issues exemplifies the tension between preserving autonomy and protection of the individual. A hospital admission can act as a watershed point whereby a view is taken that the person requires a different approach to their care. If the person comes from a domestic setting, this may lead to instigating or modifying an existing care package or moving to a care home. Furthermore, it is generally accepted that the services available in the community for this large and growing patient group are inadequate, the applicable legal framework itself is often complex and unwieldy and, inevitably, the planning process involves more than a single agency. We discuss the key legislation, guidance and processes relating to discharge of a person with dementia from both general and psychiatric hospital settings.