Community Treatment Orders: the psychiatric ASBO?

Saturday 18 October, 17.30 until 18.45, Pit Theatre, Barbican Legal Challenges

When Community Treatment Orders (CTOs) were created under the Mental Health Act 2007, it was hoped that psychiatric patients discharged from hospital subject to such an order would be more likely to continue taking their prescribed medication, therefore reducing their risk of future relapse and of being readmitted to hospital. Non-compliance with medication was seen by some as a key factor not only in ‘revolving door’ patients but was also implicated in several high-profile tragedies where discharged patients had killed others or themselves. It was hoped by many leading professionals that CTOs – which can be renewed every six months - could provide reassurance over public and patient safety and still allow former in-patients, particularly ones prone to relapse, to take part in society with some degree of autonomy. After all, isn’t it preferable for a patient to be discharged under a CTO than to be detained in hospital? Is there any clear ethical distinction between treatment being given in a hospital setting to that same treatment being given in the community?

There is a growing anxiety, however, that not only have CTOs failed to curb hospital readmissions but that they are being over-issued. There is increasing concern that they are being used as an easy substitute for hospital treatment by cuts-hit and over-stretched mental-health services, with vulnerable patients often more likely to receive emergency treatment at the hands of poorly-trained police than mental-health professionals. For others, however, there are broader civil-liberties concerns, with CTOs being dubbed ‘the psychiatric ASBO’, with patients who would otherwise have been discharged now subject to unwanted and intrusive monitoring upon their release from hospitals. Noting the public outcry over the Sun’s misleading claims surrounding violent crimes committed by ‘mental patients’ (actually below the national average), it is argued that CTOs were a panicked response to an exaggerated danger posed by those with a history of severe mental illness. Regardless of the statistics, however, can society, government and professionals ignore the problems - including those violent incidents committed by ex-patients - that are, at least in part, a result of the commitment to move the majority of mental-health care from the closed institution to the open community?

Are CTOs simply an inadequate policy response to the requirements of ‘care in the community’ or are they a manifestation of risk-averse practice within mental healthcare? Given the statistically low risk posed to society by ex-patients, have government and health professionals done enough to challenge the stigma associated with community-based treatment? Has the move towards non-compulsory detention been to the general benefit of patient safety, and do CTOs advance or hinder its impact? Have recent cuts created a crisis in mental healthcare provision?

Listen to the debate:

Anthony Maden
Emeritus Professor of Forensic Psychiatry, Imperial College London

Dr Ken McLaughlin
lecturer in social work; author, Surviving Identity: vulnerability and the psychology of recognition

Professor Sir Simon Wessely
president of the Royal College of Psychiatrists; head of the Department of Psychological Medicine at the Institute of Psychiatry, Psychology and Neuroscience, King's College London

Dr Frankie Anderson
psychiatry trainee; co-founder, Sheffield Salon

Produced by
Dr Frankie Anderson psychiatry trainee; co-founder, Sheffield Salon
David Bowden associate fellow, Academy of Ideas; culture writer
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Community Treatment Orders

This section explains how a CTO is made and what your rights are

Rethink mental illness

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