Health
What Capacity Isn’t
Untangling the difference between agreement and understanding
“I said yes. Doesn’t that mean I understand?”
Not always. And in hoarding work, this distinction matters more than most professionals realise.
We often meet people who appear articulate, agreeable, and compliant during assessments. They nod, make eye contact, even say the right things. But what’s missing is the depth — the internal grasp of what’s being asked, what the risks are, and what the consequences might be.
That’s the illusion of insight.
Take David, a man in his 60s, known to services for years. Multiple safeguarding concerns. Fire risk. Self-neglect. At every meeting, he smiles politely and says he understands. “Yes, yes — I’ll clear it. Yes, I know it’s not safe.”
But nothing changes. Because understanding isn’t just about repetition — it’s about retention, application, and appreciation of risk.
When we assessed David’s capacity, we took our time. We slowed the conversation. We used visual prompts. We asked him to explain back in his own words. And when we asked what would happen if he didn’t clear a path to the kitchen, he said, “I’ll get told off again.”
Not “I might fall.” Not “I can’t get to food.” Just: “They’ll be cross with me.”
Capacity assessments in hoarding cases aren’t about catching someone out — they’re about safeguarding. They must be done carefully, ethically, and with a full understanding of how trauma, executive function, and masking can distort what we see.
Compliance is not the same as capacity. And saying “yes” doesn’t always mean “I understand.”
Written by:
Johanna Dowdeswell, Occupational Therapist
Part of the Enabling Spaces CIC “Insights from the Frontline” series
