Aims and method To ascertain the competence of voluntary psychiatric patients to consent to neuroleptic medication and whether there is a hierarchy of tests of competence. A prospective, observational study of consecutive, voluntary admissions to an acute ward using a questionnaire designed to test four levels of competence, the Mini-Mental State Examination and the Brief Symptom Inventory. Results All subjects (n=40) could communicate a choice; 5% were competent at all levels. Tests were

more »

... ary and not hierarchical. Symptom relief/trust in doctors motivated most decisions to accept treatment. Clinical implications The number and identity of individuals identified as competent will vary with the test set, and tests limited to cognitive criteria will not cover the complexity of the task.