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Legal changes

A new approach to Community Treatment Orders

The Mental Health Bill aims to bring the Community Clinician to the forefront of any decisions in respect of the patient’s CTO.

As referred to in our overview briefing on the draft Mental Health Bill, this is one of a series of additional briefings to review the proposals in more detail.

Community Treatment Orders (CTOs) were brought in by the 2007 amendments to the Mental Health Act (MHA). Now, some 14 years later, it is felt that these are overused and the draft Mental Health Bill (the Bill) sets out a number of proposals, seeking to restrict and regulate their use.

S17A of the MHA allows a patient who is detained in hospital to leave the hospital setting and be treated in the community under a CTO if certain criteria are met.

The changes to the use of CTOs, reflect the Bill’s key principles:

  1. Choice and autonomy — ensuring that patients’ views and choices are respected;
  2. The least restrictive option — ensuring that MHA powers are used in the least restrictive way possible;
  3. Therapeutic benefit — ensuring patients are supported to recover so that they can be discharged from the MHA; and
  4. The person as an individual — ensuring patients are viewed and treated as individuals.

Changes to the criteria for a CTO

As well as the existing criteria, the Bill includes a new two-part test that must be fulfilled to meet the criteria for detention (the amendments to the criteria will be subject to a separate briefing), renewal and for the use of CTOs:

  1. Serious harm may be caused to the health or safety of the patient or another person, if they are not detained or made subject to a CTO; and
  2. The decision maker must consider the nature, degree and likelihood of the harm, and how soon it would occur.

Conditions on a CTO

The draft Bill alters the basis required in order to impose a CTO condition. Subsection (1) of Clause 20 of the Bill, provides that a CTO may only be used where ‘necessary’ for that particular patient. Previously, conditions could be used where ‘necessary or appropriate’.

Removing the ability for conditions to be imposed where simply ‘appropriate’, aligns with the principle of therapeutic benefit, by ensuring that conditions are only imposed where there is a strong justification for their use. It removes the need for a complex assessment of what is ‘appropriate’ for a patient, which may well be contentious, and helps ensure patients are treated as individuals.

The role of the Community Clinician

A patient who is subject to a CTO will have been placed on this by their responsible clinician (RC). Once in the community they will be supervised by a community clinician who may or may not be the same person as their RC.

The Bill aims to bring the Community Clinician to the forefront of any decisions in respect of the patient’s CTO to assist with continuity of care. This includes the core decision to impose a CTO, vary its conditions, or discharge the CTO altogether.

The main proposals can be summarised as follows:

  1. The Community Clinician must approve the CTO conditions, in addition to the approved mental health professional as is currently required;
  2. The RC must consult the Community Clinician before varying or suspending any conditions;
  3. The Community Clinician must be consulted before the RC recalls a patient back to hospital;
  4. The Community Clinician must be consulted before a CTO is revoked and the patient placed back under section, the CTO is extended, or it is discharged.

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