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Is the bark worse than the bite? Additional conditions used within community treatment orders

  • Mike Smith (a1), Tim Branton (a2) and Alastair Cardno (a3)
Abstract
Aims and method

To investigate the use of additional conditions attached to community treatment orders (CTOs) and whether they influence the process of recall to hospital. We conducted a retrospective descriptive survey of the records and associated paperwork of all the CTOs started in the trust in the year from January 2010. Each CTO was followed up for 12 months.

Results

A total of 65 CTOs were included in the study; 25 patients were recalled during the study and all but one of these had their CTO revoked and remained in hospital. Each patient whose CTO was revoked had experienced a relapse in their condition. Many patients had not complied with CTO conditions prior to relapsing and could potentially have been recalled earlier.

Clinical implications

Our findings suggest that the breaching of additional CTO conditions does not tend to result in a patient's recall to hospital. This has implications regarding how the workings of CTOs are explained to patients and regarding the utility of additional conditions more generally.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Mike Smith (m.smith15@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Macpherson, R, Molodynski, A, Freeth, R, Uppal, A, Steer, H, Buckle, D, et al. Supervised community treatment: guidance for clinicians. Adv Psychiatr Treat 2010; 16: 253–9.
2 Churchill, R, Owen, G, Singh, S, Hotopf, M. International Experiences of Using Community Treatment Orders. Department of Health, 2007.
3 Kisely, S, Campbell, LA, Preston, N. Compulsory community and involuntary out-patient treatment for patients with severe mental disorders. Cochrane Database Syst Rev 2005; 3: CD004408.
4 Swartz, MS, Hiday, VA, Swanson, JW, Wagner, HR, Borum, R, Burns, BJ. Measuring coercion under involuntary outpatient commitment: initial findings of a randomized controlled trial. Res Community Ment Health 1999; 10: 5777.
5 Evans, R, Makala, J, Humphreys, M, Mohan, CRN. Supervised community treatment in Birmingham and Solihull: first 6 months. Psychiatrist 2010; 34: 330–3.
6 Malik, M, Hussein, N. Qualitative outcome for community treatment orders. Psychiatr Bull 2009; 33: 437–8.
7 Lepping, P, Malik, M. Community treatment orders: current practice and a framework to aid clinicians. Psychiatrist 2013; 37: 54–7.
8 Patel, MX, Matonhodze, J, Gilleen, J, Boydell, J, Taylor, D, Szmukler, G, et al. Community treatment orders, ethnicity, conditions and psychotropic medication: the first six months. Schizophr Res 2010; 117: 493–4.
9 Health and Social Care Information Centre. Inpatients Formally Detained in Hospitals under the Mental Health Act 1983 and Patients Subject to Supervised Community Treatment – England 2010–2011, Annual Figures. HSCIC, 2011.
10 Department of Health. Code of Practice: Mental Health Act 1983. TSO (The Stationery Office), 2008.
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BJPsych Bulletin
  • ISSN: 2053-4868
  • EISSN: 2053-4876
  • URL: /core/journals/bjpsych-bulletin
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Is the bark worse than the bite? Additional conditions used within community treatment orders

  • Mike Smith (a1), Tim Branton (a2) and Alastair Cardno (a3)
Submit a response

eLetters

Misunderstanding recall

Keith E. Dudleston, Retired Consultant Psychiatrist
14 April 2014

Smith et al should be congratulated for their investigation into the use of the additional conditions that are sometimes included in Community Treatment Orders (CTOs) (1). The Reference Guide to the Mental Health Act 1983(15.16 - 15.19), and the Code of Practice (25.29 - 25.35), describe the nature of these conditions and how they relate to the recall of patients. While patients do not have to consent formally to CTOs, or the conditions,in practice they will need to attempt to co-operate with them. However, these additional conditions are not directly enforceable. The Reference Guide (15.30) sets out the criteria the Responsible Clinician must use when considering recall. These criteria do not refer to additional conditions, and there is no power of recall if a CTO patient fails to comply with them. I agree with Smith et al when they claim that many CTO patients wrongly believe that if they are unable to adhere to additional conditions they will inevitably be recalled to hospital, and that the prevalence of this misunderstanding is inconsistent with the principles set out in Chapter1 of the Code of Practice.One of the roles of independent mental health advocates is helping patients obtain information about, and understand their rights under, the Mental Health Act 1983. In my opinion this is an issue that they should prioritise, as should all those who monitor the use of this act. AsSmith et al point out, these circumstances raise serious legal and ethical issues.

References:

1. Smith M, Branton T, Cardno A.Is the bark worse than the bite? Additional conditions used within community treatment ordersPsychiatric Bulletin 2014; 38: 9-12.

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Conflict of interest: None declared

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