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Community based compulsory treatment

 

All existing compulsory treatment orders and community based compulsory treatment orders by NHS Board census date 6 January 2010

 

 Health Board  CTO
Community
Based		  CTO
Hospital
Based		  Totals  %
Community
Based
 Ayrshire & Arran  30 93  123  24% 
 Borders  10 15   25  40%
 Dumfries & Galloway  23  39  62  37%
 Fife  54  98  152  36%
 Forth Valley  36  71  107  34%
 Grampian  47  112  159  30%
 Greater Glasgow & Clyde  190  361  551  34%
 Highland  48 81   129 37% 
 Lanarkshire  50 78   128 39% 
 Lothian  111 252   363   31%
 Shetland  2 0  2   100% 
 State  0 29  29   0%
 Tayside  52 144  196   27% 
 Western Isles  1 3  4  25% 
 Totals  654 1376  2030   32%

*Last year we reported on 1,854 CTOs. We didn not think this reflected the total number of CTOs. We have worked hard to make sure that we got better information this year. The number of people on CTOs has not, however, gone up significantly this year.

 Our interest in this

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 being delivered in the community. We wanted to see if this varied across the main NHS Board areas. Unfortunately we can't report this for local authority areas, because we don't always have up to date details of an MHO's employer.

What we found

We looked for NHS Boards where the use of community CTOs was obviously higher or lower than the national average. The important findings are:

  • NHS Borders has the highest proportion of community based compulsory  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. Lanarkshire is not far behind.
  • Ayrshire and Arran has the lowest use of community based compulsory treatment, followed by Tayside. The presence of independent sector hospitals with regional or national intake might skew some of this data.

A key principle of the 2003 Act is minium restriction of an individual's freedom. Areas that have relatively high use of compulsory treatment, but low use of community orders, should make sure that they have adequate services to provide community based compulsory treatment and that the use of community CTOs is routinely considered as an option for individual care and treatment.

Granting, recalls and revocation of community CTOs 2009-10

AR-09-10-Table26

We have looked at the lengths of all CTOs and compared hospital and community orders. This year, for the first time, people who have been subject to a CTO for more than two years, but less than five years, are more likely to be treated in the community. This is an encouraging finding and is in keeping with the principle of least restriction of freedom.

Our interest in this

We take great interest in how community based compulsory treatment works. We want to see how people come to be on community based CTOs, how often these orders are revoked and the reasons for people being brought back into hospital.

There are two reasons why a person on a community based CTO 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 attend for medical treatment (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 community based CTOs has become stable over the last year.  We may not yet have details on all revoked orders.

This year, 147 people on community orders were readmitted to hospital under compulsory measures (combination for S113/114 and EDC/STDC). Last year 184 people were readmitted. The number of variations from community orders to hospital orders has dropped from 38 to 28. These are encouraging figures. They suggest that compulsory treatment in the community is working better. We will visit people on community CTOs this year to satisfy ourselves that this is the case.

We still see very little use of S112 to provide care and treatment to people in the community. We think this legal provision provides a useful, less restrictive alternative to a hospital recall and should be used as an alternative to readmission to hospital, where appropriate.

The use of community compulsory treatment has gone up in the last three years. We wanted to see whether people were more or less likely to be readmitted from community orders over this time. This is shown in the figure below.

Readmissions and variations back to hospital compulsion from community CTOs, 2007-10

Fig-26a

Readmissions and variations from community CTOs as a percentage of all extant orders, 2007-10

 

Fig-26b

We are encouraged by the fall in readmissions from community CTOs. This year, the number of compulsory readmissions of all types has fallen, as has the number of variations back to hospital based orders. We are especially encouraged because the percentage of people readmitted from community orders has almost halved since 2007-8.

We aren't informed when people are readmitted informally while on community orders. Also, we need to be sure that people are getting good quality care and support in the community. We are arranging to visit people on community CTOs as part of our 2010-11 monitoring programme.