Simmons et al ^{Reference Simmons, Hawley, Gale and Sivakumaran1} suggest that the majority of recipients of mental health services do appear on the whole to prefer the term patient, according at least to evidence from studies in London and Hertfordshire.

Although our guidelines prefer other terms, the American Psychiatric Association practice guidelines ² exclusively use the collective patients to refer to individuals receiving psychiatric care. Similarly, the Canadian Psychiatric Association clinical practice guidelines (such as those for treatment of depressive disorders ³ ) refer solely to patients. Although other terminology is in use and under debate, patients is possibly also preferred by Canadian recipients. ^{Reference Sharma, Whitney, Kazarian and Manchanda4} Cultural differences in attitudes to psychiatry and the organisation of healthcare services may account for the difference in terminology.

I wonder to what extent individuals receiving mental health services who are or have been detained formally under the Mental Health Act in the UK would consider themselves clients or service users. It is possible that those that have been detained (currently or in the past) may prefer the term patient (because they were admitted to a hospital), whereas those individuals who receive or have received treatment primarily in the community may have a different perspective of mental health services and prefer terminology with fewer associations with perceived paternalism.

A final consideration might be to what extent the incorporation of the terms client and service user into psychiatric parlance, if fully embraced, would be practical when taken to its logical conclusions - should we, for example, be referring to ‘in-clients’ and ‘out-clients’ rather than in-patients and out-patients?