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We describe how Supervised Discharge (Section 25) of the Mental Health Act 1983 was used to promote mental health care in the community for a man with mild learning disabilities and paranoid schizophrenia who has had repeated relapses and hospital admissions. The new compulsory Community Treatment Order in England and Wales introduced by the Mental Health Act 2007 is explored in comparison with Section 25 Supervised Discharge, which it has now replaced, and compared with similar legislation already introduced in Scotland. The practice implications of the new supervised community treatment orders are discussed.

The UK government's Mental Health Act 2007 introduces compulsory supervised community treatment (SCT) to England and Wales. Estimates of the possible level of use of SCT are helpful both to address patient fears and to plan services. The number of patients under SCT is likely to rise over time, although the level of use will depend on a number of contextual variables and whether evidence of clinical and social benefits is forthcoming.

The new Mental Health Act 2007 substantially amends the Mental Health Act 1983. In this article, some of the most important changes are highlighted, including changes to the definition of mental disorder, the new professional roles of approved mental health practitioner and responsible clinician, and the new powers for Supervised Community Treatment. The likely impact of these changes for people with learning disability and professionals working with them is discussed.

This paper explores the perspectives of patients subject to supervised community treatment (SCT) within two mental health teams in Merseyside.

A structured survey tool was developed to explore patient perspective. In total, 17 patients agreed to participate in the study subject to informed consent.

The majority of patients believed SCT facilitated early hospital discharge but felt uninvolved in the process. A significant proportion lacked the motivation or ability to understand the verbal and written information pertaining to their legal rights at the time it was given, usually immediately prior to hospital discharge. All felt they must strictly abide to the SCT conditions to remain in the community. There was a lack of knowledge about the harm criteria and the responsible clinician's ability to recall a service user to hospital even if they abided by the conditions.

This study is based upon a small sample size. There is no attempt to generalise the results.

There have been few studies exploring the perspective of patients subject to SCT. A fuller awareness and understanding of patient perspective is important to promote involvement and therapeutic outcomes.

This paper aims to set out the views of approved mental health professionals (AMHPs) on the impact of supervised community treatment (SCT) on their work and their patients' lives in the community.

The study covered a total of 56 community treatment order (CTO)‐related activities undertaken in 2010 in a local social services authority (LSSA) in the north west of England, and looked at data from the records of 25 CTO patients. Nine AMHPs responded to a CTO outcomes questionnaire and five participated in a focus group.

The characteristics of CTO patients in this LSSA study were consistent with national data. AMHPs were often undecided about the benefits of CTOs to their patients. A majority agreed that CTOs could benefit patients by earlier identification of relapse, improving access to housing and reducing the risk of avoidable harm to self or others. However, a majority also agreed that CTOs had not improved patients' access to employment, education, training or recreational activities; nor had they helped reduce the stigma and discrimination that patients faced.

This was a relatively small‐scale study. However, its findings are consistent with previous work in this area, and provide pointers to how SCT can be more effectively implemented across England.

There is very little published research into the impact of SCT in England. Although small in scale, this study provides valuable insights into the views of AMHPs, who play a core role in the CTO process.

The UK Government has been planning changes to mental health legislation for at least eight years. On 23 March 2006, the Department of Health announced that many of these plans would proceed ‐ although through amendments to the 1983 Mental Health Act rather than a substantive Bill. These proposed reforms are significant but controversial. This paper sets out some of the reasons for welcoming the proposed changes. It is argued that the proposals to replace the responsible medical officer with a clinical supervisor are in keeping with best quality mental health care, and allow for proper multidisciplinary practice. Such an approach explicitly permits proper use of the skills and competencies of the workforce ‐ including psychologists. A second controversial aspect of the proposed reforms ‐ supervised community treatment orders, permitting compulsory care outside of hospitals ‐ represent not a violation of human rights, but a specific defence of ‘Article 8’ rights to protection of family and personal life. Finally, it is argued that the proposed amendments are important because mental health legislation dominates mental health care and the present 1983 Mental Health Act inappropriately consolidates the status of the medical model and the role of the responsible medical officer (and hence psychiatry). It is argued that the proposed changes are imperfect; in particular they lack inclusion of an ‘impaired judgement’ criterion, but it is suggested that necessary role and service redesign needs such amendments to allow the new ways of working programme to ‘bite’.

The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 within England and Wales as a framework for making decisions about incapacitated persons' care and treatment generally not amounting to a deprivation of their liberty (although such could be authorised under its powers by the new Court of Protection). From a planned date of April 2009, the MCA is to be enlarged by the provisions of the Mental Health Act 2007 (MHA 2007) to encompass deprivation of liberty, with the addition of a new framework of Deprivation of Liberty Safeguards (DOLS). The MHA 2007 also revised significant aspects of the Mental Health Act 1983 (MHA), which were implemented in November 2008. The interface between the MCA, as amended to include DOLS, and the revised MHA is complex and potentially ambiguous. This paper describes in detail some issues that may arise at the interface of the two acts, and seeks to inform professionals involved in the use of these legal frameworks of the resulting complexity.

The purpose of this paper is to explore use of community treatment orders (CTOs) in adults with intellectual disability (ID) and mental health problems across England and Wales.

A web-based exploratory survey was sent to 359 consultants on the database of the Faculty of the Psychiatry of ID, Royal College of Psychiatrists who had declared ID as their main speciality. Socio-demographic details of responding consultants, clinical characteristics of adults with ID on CTO, subjective views of consultants on using CTOs in people with ID were collected and analysed.

In total, 94 consultant questionnaires were returned providing information on 115 patients detained under CTO. More than 75 per cent of the respondents had used CTO in their clinical practice. Patients subject to CTO were generally young, white males with mild ID and living in supported accommodation. CTOs were primarily used in situations of non-engagement (52.2 per cent), non-compliance with medication (47 per cent) or non-compliance with social care supports (49.6 per cent).

Responding consultants expressed concerns about encroachment of civil liberties and ethics of using CTOs in people with ID who may lack capacity and stressed that decision to use CTOs needs to be therefore done on individual basis.

This is the first national study to examine the practice of applying CTOs in adults with ID and mental disorders. Current practice is based on evidence from research done in adults with normal intelligence. Further research is needed to investigate the utility of CTOs in routine clinical practice in adults with ID and mental disorders.

The literature on the use of Community Treatment Orders (CTOs) is primarily focused on people without intellectual disabilities. This paper aims to explore how CTOs are used in people with intellectual disability in the UK.

An audit was conducted among Consultant Psychiatrists in intellectual disability psychiatry in Nottinghamshire Healthcare NHS Trust. Each consultant was asked to provide information on demographic data of their patients on CTOs, reasons for being on a CTO, conditions specified, patients' capacity to consent and their understanding of their CTOs. Conditions of CTOs were analysed using thematic analysis.

There were 17 CTOs done for patients with intellectual disability from November 2008 to May 2011. Mean age was 38 with a range of 20‐59. All patients had a mild or moderate intellectual disability. Only a small percentage of patients had a diagnosis of schizophrenia. More than 50 per cent had a diagnosis of pervasive developmental disorder (PDD). All patients had behavioural problems as a reason for being on a CTO. About one third of patients did not have any understanding of their CTOs. Themes of conditions were focused on providing a structured life to prevent relapse of the mental disorder.

This paper highlights that CTOs are used differently in the intellectual disability population. CTOs are adapted to use for patients with behavioural challenges and PDD in an intellectual disability population. This contrasts with its common use to manage non‐compliance with medication in patients with schizophrenia in the general adult population. This paper also suggests the main themes of conditions which clinicians can use when deciding on CTO conditions.

Managing the risk of sex offending and sexually harmful behaviour presented by some men with intellectual disabilities is enhanced if community services map the number in their catchment area, apply appropriate risk assessment and management methods, and implement evidence‐based treatment. This paper describes the methods and progress of one community intellectual disability service in mapping and assessing the risks. A second paper is planned that will address progress in treatment.