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The gap between voluntary admission and detention in mental health units
  1. Rachel Bingham
  1. Correspondence to Dr Rachel Bingham, Amwell Group Practice, 4 Naoroji Street, London WC1X 0GB, UK; rachelbingham{at}


This paper presents the case of a young man with a diagnosis of schizophrenia, who agreed to inpatient treatment primarily to avoid being formally detained. I draw on Peter Breggin's early critique of coercion of informal patients to supply an updated discussion of the ethical issues raised. Central questions are whether the admission was coercive, and if so, whether unethical. Whether or not involuntary admission would be justified, moral discomfort surrounds its appearance as a threat. This arises in part from ambivalence about autonomy: although a ‘choice’ is made, the threat of detention impinges on the patient's choice. Recent legal developments provide some experience of safeguarding those whose consent is not obtained. This highlights the lack of safeguards in this ‘gap’ and suggests that we have the tools with which to begin to deal with the problem.

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  • Competing interests None.

  • Patient consent To maintain confidentiality the person described is derived from several others and not recognisably any single person I have encountered.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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