As a consultant in the psychiatry of learning disability for the past 18 years, I had assumed that the Mental Health Acts referred to those patients who have some understanding of the concept of treatment and who are able to clearly express an objection to any proposed management. Those who could not express an objection because of severe handicap (“non-volitional patients”), I treated as informal patients. This view was supported by a representative of the Medical Protection Society, with whom I had discussions soon after I became a consultant. It agrees with the assumption that is widely held that for informal admission to occur, a person need not express positive willingness to be admitted to hospital, that it is sufficient that he is not unwilling to be treated in hospital (Gostin, 1983).
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