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Community Treatment Orders: Are they useful?

Our People - Lilian Efstathiou
29 January, 2020

Hospitalisation for mentally ill individuals remains one of the most prominent ways for treating mentally ill people who present a risk to themselves or others. However, following the enactment of the 2007 legislation and in accordance with s17A of the Mental Health Act 1983 (as amended), the responsible clinician can discharge a patient to the community while still holding the power to recall that person back to hospital if needed. This is commonly known as a Community Treatment Order (CTO) or otherwise known as a Supervised Community Treatment (SCT).  

A CTO means that a person who was previously detained in hospital may receive their treatment in the community with certain conditions.  Although the Act fails to provide a formal definition for a CTO, paragraph 107 of the explanatory notes to the 2007 Act explains that patients who are on a CTO will have to comply with conditions in the community. The conditions will differ depending on each unique case, however, most conditions are in place in order to ensure compliance with treatment and as a preventive method to avoid risk of harm to the patient or to others. 

It must be noted that not every detained person fits the criteria for a CTO. Section 17A paragraph 4, of The Mental Health Act 1983 (as amended) provides that the responsible clinician can only order a CTO if the criteria mentioned below are fulfilled.  

  • the person must have a mental disorder of a nature or degree that makes it appropriate for them to receive medical treatment
  • it must be necessary for the person’s health or safety or for the protection of others that they should receive treatment
  • treatment can be provided in the community without the person being detained in hospital
  • it is necessary that the responsible clinician is able possible to recall the person back to hospital if needs 
  • appropriate medical treatment is available. 

Are CTOs achieving the desired outcome? 

CTOs were originally designed to be a less restrictive method of providing treatment to mentally ill patients. Over the last few years, there has been heated debate about the effectiveness and usefulness of CTO’s.  This alternative regime can prove useful when it comes to patients whose mental illness stops them from realising the benefits of treatment, in that it legally aims to ensure compliance with treatment in the community. Also, clinicians could argue that it reduces the risk of a relapse in one’s mental state as it allows a swift and quick recall back to hospital if the patient fails to comply with the conditions and as a result their mental health deteriorates.  

On the other hand, CTO’s can be perceived as a measure of depriving a person of their liberty. What cannot be overlooked, is that although treatment in the community can definitely be less restrictive, a CTO can only be put in place following a hospital admission. For the patients concerned, this could mean a longer period during which they may not have the right to make lawful decisions about their treatment and a coercive measure for them to comply with conditions. This compulsion can sometimes lead to an alienation between the patient and the community team, making their relationship a non-therapeutic one. Furthermore, the OCTET study[1]  suggests that there is no substantive evidence to support that CTOs have resulted in a decreased rate of readmissions nor in a reduced length of admissions.  Additionally, the results of the study,[2] do not indicate any differences in social or clinical outcomes. 

The government has promised to reform the Mental Health Act 1983 (as amended) in order to improve the care of those receiving treatment. It remains to be seen whether a further reform of the Act 1983 will seek to meaningfully tackle the debate around the effectiveness of community treatment orders. 

[1] Tom Burns and others, ‘Community Treatment Orders For Patients With Psychosis (OCTET): A Randomised Controlled Trial’ (2013) 381 The Lancet.

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Lilian Efstathiou is a solicitor working in the Court of Protection and Wills, Trusts & Probate departments.

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