Community based compulsory treatment
Our interest in these figures
The Mental Health (Care & Treatment) (Scotland) Act 2003 makes provision for compulsory treatment to be delivered in the community. We know that the use of compulsory community treatment (CCTOs) is replacing long-term detention in hospital. Across Scotland, we found that around 30% of all compulsory long-term treatment is now in the community. We wanted to see if this varied across the main NHS Board areas.
What we found
We looked for NHS Boards that were obviously higher or lower than the national average. The important findings are:
- NHS Borders has a high proportion of compulsory community treatment orders. Given the relatively low use of the 2003 Act in that area, there are remarkably few people detained under compulsory treatment orders (CTOs) in hospital.
- Grampian, Ayrshire and Arran and Tayside have relatively low usage of CCTOs.
- Given the high use of the 2003 Act in Tayside, the number of people detained long-term in hospital is concerning. We think this NHS Board in particular should reflect on our figures and consider whether their community services are adequate.
Figure 5: Length of compulsory treatment by order type 2008-09
Our interest in these figures
We know that about a third of all CTOs are used to treat people in the community. We looked at all people who were treated under CTOs on one particular day to find out how long, in total, they had been subject to compulsory treatment. We looked at this for people on hospital and community treatment orders.
What we found
Most people are treated on CTOs for relatively short periods. We found that:
- After 2 years, the number of people still on CTOs drops quickly and very few people are on orders for more than five years.
- People treated for less than three years are more likely to be in hospital.
- For people whose episodes of treatment are longer than three years, the order is as likely to be community-based as hospital based.
We will repeat this survey on two dates over the next year to see if episode lengths change and if there is a greater shift to community orders
Figure 6: Length of episodes of all people subject to Compulsory Treatment Orders on 28th January 2009
Our interest in these figures
When the 2003 Act was introduced, some people were anxious that they would be placed on compulsory treatment in the community for long periods of time. For all people on CCTOs in January 2009, we looked to see when the episode of compulsory treatment started.
What we found
We found a lot of people whose order was less than six months old. There is a dip before another peak between one and two years. After that, we see fewer and fewer people whose orders have gone on for long spells.
This makes us think there are two populations. One group of people need a short spell of compulsory community treatment to help ensure recovery from an episode of illness. There is another group that needs longer spells of treatment. We want to find out more about these people and will be looking into this more over the next year.
Figure 7: People on community compulsory treatment orders - number of previous compulsory episodes
Our interest in these figures
We counted the number of previous episodes of compulsory treatment for all people who are on community CTOs at present. Under the 1984 Mental Health Act, nobody could be treated in the community under a civil compulsory order for more than a year. We expected to see community CTOs being used for people with several previous episodes and long spells of leave of absence under the 1984 Act.
What we found
Most CCTOs are used for people with few previous episodes. This was not what we expected. 18% of people had no previous episodes and almost half had fewer than three previous episodes. We think that the Mental Health Tribunal considers granting community orders wherever possible. This is in line with the principle of least restriction of freedom.
Our interest in this
We take great interest in how compulsory community treatment works. We want to see how people come to be on CCTOs, how often these orders are revoked and whether people need to be brought back into hospital.
There are two reasons why a person on a CCTO might be compulsorily admitted to hospital. If people do not comply with the order (e.g. do not attend for treatment or allow support services into the house), they can be recalled under sections 113 (72 hours) then section 114 (28 days). There is a provision to take someone to hospital or some other place of treatment for 6 hours if he/she refuses to take medication (section112). People who comply with the order but become unwell can be admitted under emergency or short-term detention. Of course, people may agree to come to hospital voluntarily for treatment but we are not informed when this happens
What we found
The number of people on CCTOs continues to rise. Around 400 new or varied orders authorised community measures. Only 250 orders were revoked and some were varied back to hospital.
About a third of all people on CCTOs are taken into hospital under a compulsory order. This has been a consistent finding for the last few years. We still find a low use of section 112 to make sure the person receives medication but can still live in the community. It is possible that it is used more than we are aware of, but that this is notified on the wrong form.
We think section 112 is a useful provision and is less restrictive of the person's liberty than recall to hospital and we think it should be used more often.
Annual reports
- directors introduction
- overview of the Mental Health (Care & Treatment) (Scotland) Act 2003 introduction
- new orders granted in 2008-09
- total numbers of 2003 Act orders in existence
- monitoring our priority areas
- monitoring of priority areas
- overrides of advance statements
community based compulsory treatment
- services for young people
- additional findings from our monitoring of mental health law
- our overview of the use of the Adults with Incapacity (Scotland) Act 2000