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Compulsory treatment orders

 

Compulsory treatment orders by age and gender 2009-10


 

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Our interest in this

Compulsory treatment orders (CTOs) are granted by the Mental Health Tribunal. They last for up to six months, can be extended by the responsible medical officer for a further six months and then extended annually. The Tribunal reviews these orders at least every two years. Therefore, they can restrict or deprive 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 trends. Over recent years, the number of new orders has come down. They are usually used more for men than women. We have been examining the use of CTOs for older people as we had seen some increase in people aged 85 and over, although we did not find a consistent trend.

What we found

  • The total number of new CTOs has risen this year. The nuber had falled last year and appears to fluctuate year by year. There is no overall trend.
  • The number of CTOs for older people (aged 65 and over) has gone up compared with the previous three years.  There were304 orders this year, compared with 254 last year - an increase of 20%. We are seeing an increased used of emergency, short-term and long term civil orders for  older people that cannot be explained by a rise in the elderly population.
  • There has been a steady fall in the granting of CTOs for young people (under 18). There were only 18 new orders this year compared with 23 for the past two years and 26 in 2006-7.
  • 56% of all new CTOs were for men. We have consistently found that men are more likely to be subject to CTOs than women. There has been a big rise in the granting of CTOs for men in the 65-84 age group (137 compared with 92 last year).

 

New compulsory treatment orders granted 2006-10 by age group 

Fig-11

 

This figure shows that the granting of new CTOs has reduced or at least been stable for most age groups. The rise this year is mainly due to an increased use of CTOs for older people. We are examining the characteristics of people who are subject to compulsory orders and are 65 or over.

 

Pattern of progression to compulsory treatment orders 2009-10

 

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Our interest in this

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 when reading this section.

What we found

This year we found that nearly half of all CTOs are granted without an interim order. This is a much higher proportion than the previous two years. Everyone accepts the need to reduce the number of multiple hearings and appears that there is a reduction this year. We still think the 2003 Act should be amended to further reduce the number of interim hearings.  We think this can be achieved while still fully respecting the rights of the individual.

Number and rate per 100k population of compulsory treatment orders granted 2009-10

 

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 Our interest in this

Compulsory treatment orders (CTOs) are used to authorise long-term compulsory treatment. Each year, we look at how these orders are used in different NHS Board areas. We always find large variations and causes are not easy to explain. Although more people with severe and enduring mental illness tend to live in inner city areas, this does not explain the variations that we see. We are concerned that areas with high use may be intervening excessively, where there may be alternatives to depriving people of their liberty. Low use could mean that people are not being adequately treated or protected. There is also a risk that excessive persuasion is used to treat people in hospital. Practitioners must take care to make sure they are not unlawfully depriving people of their liberty. 

Last year, we looked at the average over the previous three years and found that Fife and Tayside have the highest number of new CTOs granted over that time.

What we found

  • NHS Lanarkshire and NHS Borders have low CTO rates. Borders has the lowest overall rate of use of the 2003 Act of all NHS Board areas.
  • The highest rate of new CTOs is in NHS Highland. Fife remains high but Tayside was lower this year. NHS Greater Glasgow and Clyde has a higher use of new CTOs than previous years. This area has a very high use of all the main civil compulsory orders. The opening of Rowanbank Clinic, which receives transfers from the State Hospital, may have had a minor effect on the higher number of CTOs
  • Some national or regional services might be skewing some of this data. For example, there are regional medium secure services in Glasgow and Lothian, an independent sector low secure facility in Ayrshire and learning disability facilities in Fife and Tayside that take people from outside their NHS Board area. We think the overall effect is relatively minor but could affect rates in smaller NHS Board areas.

The NHS Board areas that we have identified should examine this data and look for possible explanations. They should also look at our data on the total number of mental health act orders in existence. NHS Greater Glasgow and Clyde in particular may need to examine the reasons for increased intervention under mental health legislation.