Compulsory treatment orders
Our interest in these figures
Compulsory treatment orders (CTOs) are granted by the Mental Health Tribunal. They last for six months, can be extended by the responsible medical officer (RMO) for a further six months, and can then be extended annually. The Tribunal reviews CTOs at least every two years. CTOs can potentially restrict or deprive individual liberty for long periods of time.
We look at how these orders are used for people of different ages and genders to see if there are any key differences and trends. Over recent years, the number of new orders has decreased. We have also found that CTOs are usually used more for men than women. We have seen some increase in use for older people in recent years.
What we found
- The total number of new CTOs has fallen for the second year in a row. Until 2007-08, the number of new long term orders was rising. There were 15% fewer CTOs granted this year than there were 2 years ago.
- The number of CTOs for older people (65+) has not gone up compared with the last two years. This is in contrast to a rise in short-term detentions in this age group over the same time period.
- 57% of all new CTOs were for men. This is a slightly higher proportion than previous years.
- While the number of CTOs has reduced, the reduction has been greater for women that for men. Compared with two years ago, 21% fewer CTOs were granted for women, compared with 10% fewer for men.
The fall in the number of CTOs may reflect the stricter criteria of the 2003 Act and/or better ways of engaging people in informal treatment. It is possible that the procedure for granting a CTO, especially the likelihood of more than one Tribunal hearing, deters practitioners from applying. If so, it will be interesting to see what happens if the law is amended to streamline the procedure.
The gender difference in the use of CTOs is growing. The reduction in use of CTOs is more apparent for women than for men. We think this may be due to higher incidence of severe and enduring mental illness, complicated by use of drugs and alcohol, in the male population.
Our interest in these figures
When the Tribunal receives an application for a CTO, it must hold a hearing. Sometimes, hearings result in an interim order for up to 28 days. There can be a further interim order before a final decision is made. There has to be a hearing each time. Multiple hearings can be distressing for service users, time consuming for practitioners and expensive to deliver. We look at how many of the applications notified to us result in interim orders as opposed to full CTOs. Because of delays in transfer of information from the Tribunal, our data is not always complete. This should be kept in mind as you review this section.
What we found
Last year, we found that around 64% of all applications to the Tribunal resulted in an interim CTO. We found much the same this year. Despite everyone's desire to reduce the number of interim orders and multiple hearings, we find no evidence that this is happening.
It is very important that the Tribunal carefully considers the need for the CTO and for the measures that are sought. This must be done in a way that protects the rights of the individual, but also in the most efficient manner possible. When commissioning an independent limited review of the 2003 Act, the Scottish Government accepted the view that the process took too much time and was too expensive. Our information suggests that this continues to be the case.
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
- additional findings from our monitoring of mental health law
- our overview of the use of the Adults with Incapacity (Scotland) Act 2000