Mental Health Act needs more monitoring as use of compulsory powers rises, says Alliance

3 November 2009

On the first anniversary of the Mental Health Act today, the Mental Health Alliance has expressed deep concern at the number of Community Treatment Orders issued since 3 November 2008. Over 4,000 people are currently subject to the Orders which make it compulsory to receive mental health treatment outside hospital.

The 2007 Act introduced community treatment orders (CTOs) into English law. They allow people detained in hospital to be discharged into the community with a requirement to comply with certain conditions, including medical treatment and restrictions on where they live and where they go, or face being returned to hospital against their will.

Alliance Vice-Chair Dr Rowena Daw said "The new law is working in an unbalanced way. There is more coercion without adequate safeguards, to the detriment of individual patients.

"While there is no firm evidence as to the precise reasons for the high use of this new power, it demonstrates clearly that if the entry point for CTOs is very broad the numbers of people on them will be correspondingly large. This flies in the face of the government’s stated intentions for their use. It will lead to widespread use of this coercive regime in the community. That puts extra pressure on services and means that individuals and their families are put under unnecessary restrictions in how they live their lives.

"If this situation persists we risk finding ourselves in a situation, as has been found overseas, where a community treatment order becomes the way in which people with mental illness are assured of close ongoing care once they are discharged from detention in hospital. While positive risk taking and choice are being seen as the way forward in all other parts of health care, the extension of compulsory mental health care takes us backwards and compounds the stigma of mental illness. It is vital that CTOs are only used when they are absolutely necessary, not as a default form of discharge nor as a way of cutting costs in inpatient services.

"There is also evidence that a high proportion of CTOs are being issued to people from Black and minority ethnic communities. This may reflect the higher rate at which people from some communities are detained under the Act. But we need to ensure that supervised community treatment does not become a reservoir from which Black and minority ethnic people cannot move on."

Paul Farmer, Chief Executive of the mental health charity Mind, said: "CTOs were intended to be a last resort preserved for a small number of patients, yet it is clear that thousands of vulnerable people are subject to them without sufficient safeguards being in place. The focus on coercion detracts from individuals' ability to rebuild their confidence and independence, both crucial for effective recovery, and the threat of compulsory treatment hangs heavy over their heads to the detriment of their mental health.

"We urge the Care Quality Commission to investigate these higher than expected numbers as a matter of urgency as the current situation is damaging patients' lives and wasting unnecessary financial expenditure."

The Alliance also noted today that in the year since 3 November 2008, overall more people are being treated under compulsory powers. As well as the high number on CTOs, the number of detentions in hospital has increased from 28,100 in 2007/08 to 28,700 in 2008/09.

The Alliance is concerned that important legal safeguards on the use of compulsion are not keeping up with demand. There are too few approved doctors to give a second opinion on the treatment plans of patients on CTOs, as the law requires. And the new legal right for people detained under the Act to have independent advocates has been slow to emerge. We understand that there is still little provision for advocacy in some, particularly rural, areas and for the most vulnerable groups of people (such as older people children and those with learning difficulties). Many of the contracts are for one year only, and the funding in some places does not reflect local need.