Non-resident orders (NROs)

Under existing law, compulsory treatment can only take place in an in-patient hospital setting. However, treatment in the community under compulsion does occur under the 1983 Act in the following circumstances:

  1. Patients subject to guardianship under the Mental Health Act. They may be required to live in a particular place, to attend a health or social care facility for treatment, or education, or training. Patients subject to guardianship must permit access to health or social care professionals. There is no authority to administer medication in the absence of consent or compliance. There is no authority to convey a person.
  2. Section 25 of the Mental Health Act. This is similar to guardianship but it can only be applied once a person has already been detained in hospital under a treatment order (section 3 or section 37).. It includes a power to convey patients, including the authority to compel a patient to attend a health care or social facility. There is no authority to compel a patient to accept medication.
  3. Section 17: leave of absence. Patients detained under section 2, 3 or 37 of the Mental Health Act may be sent on leave. Whilst they cannot be forced to have medication in the community there may be grounds for recall to hospital if the patient does not comply with their medication. Patients certainly believe they will be returned to hospital if they stop their medication. For practical purposes, therefore, this is a form of community treatment order.
  4. Patients under a section 41 restriction order who are currently on conditional discharge. Such patients are in the same position as those on section 17 leave, i.e. they have a right to refuse medication whilst in the community but most patients feel they would be ill advised so to do given the authority to recall to hospital.

For some time, the Government has been proposing to allow compulsory treatment to take place in the community, arguing that this may address the issue of repeated re-admissions to hospital and provide a less restrictive alternative to in-patient treatment. It is also hoped that this will further the objective of reducing pressure on scarce hospital beds.

The Draft Mental Health Bill states that there shall be resident (in hospital) and non-resident (in the community) status for people subject to compulsory powers. During the examination stage, if any two of the three examiners decides that a person should not be detained in hospital for the assessment, and if that person falls within a group defined in Regulations, then assessment will take place in the community.

In the case of resident patients there is a duty on the clinical supervisor to keep under review whether it is appropriate for the patient to be detained in hospital. If this is not appropriate, then the clinical supervisor must discharge the patient from hospital and specify the conditions to be imposed on the patient as a non-resident patient. The clinical supervisor must consult the nominated person and carers before making this determination. The Mental Health Tribunal can also determine that a patient can be assessed or treated as a non-resident patient.

If the patient is treated in the community a range of stipulations may be made in addition to the requirement to receive medical treatment. These may be requirements that the person concerned:

  1. attends a specified place at specified times;
  2. resides at a specified place;
  3. makes himself available for assessment during specified periods; and/or
  4. does not engage in specified conduct.

Subsequent tribunals would then reconsider individuals’ cases and decide whether to repeat or alter the assessment or treatment order. At all stages the clinical supervisor appointed over the person’s case has a duty to keep under review whether or not a patient should be a resident or non-resident patient.