Reforming the Mental Health Act – Community Treatment Orders

This next in our series of blogs on the White Paper focuses on CTOs.

We are told that these are to be reformed so that:

• they can only be used where there is a strong justification;
• they are to be reviewed more frequently; 
• they are to be reviewed by more professionals; 
• they are time limited; and
• people subject to them really need them to receive a genuine therapeutic benefit.

10 key points to note

1. The criteria for use will be revised in line with the proposed revised detention criteria for section 3. So there must be a substantial likelihood of significant harm and the CTO must provide therapeutic benefit. Thus, there will need to be evidence based on a consideration of the patient’s previous engagement with treatment plans in the community.
2. The White Paper is clear that the new requirements are not to create a barrier to prevent patients being discharged onto a CTO when this represents the least restrictive option.
3. A third decision maker is to be introduced. So the Responsible Clinician (RC) and an Approved Mental Health Professional (AMHP) need to liaise with the community supervising clinician too. All three will need to be involved in initial decisions and renewals.
4. In terms of timeframes, the expectation will be that a CTO should end after two years. This will be set out in guidance. However, if people continue to be subject to CTOs for extended periods then this may be legislated for instead.
5. The new “Nominated Person” will have a power to object. However, it will be possible to overrule them.
6. CTO conditions are to be supported by evidence and they must not amount to a Deprivation of Liberty. In addition, the Code will provide for a stronger expectation that clinicians assure themselves that patients are able to understand the conditions.
7. Tribunals will also have the power to check an RC’s justification for conditions.
8. It will only be possible to recall when it is needed because there is otherwise a substantial risk of harm.
9. The locations to which a patient can be recalled will be broadened.
10. The effects of CTOs are to be monitored over a five year period. A decrease in use is expected.

Don’t forget the consultation is open until 21 April.