The Treatment of the Voluntary Boarder
1. 1,095 cases were admitted to the Retreat as voluntary boarders between January 1, 1891, and December 31, 1930. 703 cases were admitted once. 71 men and 63 women were admitted twice or more.

2. During the period voluntary admission has been made increasingly easier, on account of a widened outlook on the part of the Commissioners of the Board of Control and of the medical authorities. Since 1925 more voluntary patients than certified patients have annually entered all the registered mental hospitals.

3. Volition at the time of admission, with the likelihood that it will continue for an appreciable period, is the only satisfactory criterion as to whether a patient may be admitted to a mental hospital as a boarder or not.

4. The results of cases staying voluntarily have been: Recovered 40%, relieved 40%, unimproved 20%. In 1,170 cases admitted under certificates, the results have been: Recovered 42%, relieved 31%, unimproved 27%.

5. The conditions under which voluntary patients are received allow a number to leave against advice. 44% of the unrecovered boarders leave in this way. Under conditions of legal detention this number would be likely to be much less, and an approximate figure for the results then is computed to be: Recovered 53%, relieved 30%, unimproved 17%.

6. A number of the voluntary admissions are highly unsatisfactory because of the attitude adopted by the patients' relatives and friends. The tiresome formalities of certification seem to instil into the relatives a profounder appreciation of the seriousness of mental disorder. Knowledge of his ability to leave the hospital of his own choice is a hindrance to the recovery of the vacillating individual, and this attitude handicaps a number of other cases rather different in type, but who are likely to recover under hospital treatment.

7. 170 voluntary cases were certified when their behaviour no longer confirmed their volition. The causes for this step were confusion, stupor, excitement, indecision, querulousness, suicidal attempts. 51% of these cases ultimately recovered. Examples of the alteration in attitude towards the necessity of certification are given.

8. Neither senile nor paranoid cases are at all times unsuitable for voluntary admission.

9. The ease with which a voluntary boarder can leave is especially dangerous for potential suicides. Possibility of suicide is a condition which is not recognized readily by the relatives, and seems sometimes to be purposely overlooked. The causes of this are discussed. Suicide of voluntary boarders within a short time of their leaving hospital care has occurred too frequently: 14 cases are known in this series.

10. Reception of patients as voluntary boarders has enabled alcoholics and psychoneurotics to seek hospital treatment. Such cases were rarely willing to come for treatment when the only mode of admission was certification. Of the 1,095 admissions, 52 were of alcoholics, and 99 were of psychoneurotics.