Supervised Community Treatment Where are we now? Malcolm King National MHA Project Lead

1. Supervised Community Treatment Where are we now? Malcolm King National MHA Project Lead National Mental Health Development Unit

2. “A predictable consequence of more control is that it will lead to further conflict. CTOs may therefore have the effect of undermining the possibility of building constructive therapeutic relationships and of working in partnership with patients towards recovery.” Community treatment orders – a bridge too far? Joanna Moncrieff and Marceleno Smyth Psychiatric Bulletin (1999), 23. 644-646 1999 - 2009

3. This workshop explores: • Application of guiding principles to SCT • How SCT is/isn’t working • Your experience of SCT

4. To what extent have the Guiding Principles informed your SCT decisions? • Purpose : Minimise undesirable effects of mental disorder/maximise safety and wellbeing (mental and physical of patients, promoting recovery and protecting other people • Least restrictive alternative : minimise restrictions on actions taken without patients consent, having regard to purpose for which restrictions are imposed • Respect : recognise diverse needs, values and circumstances; patients views wishes and feelings. Non discrimination.

5. Participation : patient involvement in care planning; views of significant others and carers • Effective, efficient equitable : use of resources

6. Especially the “Purpose” principle “The purpose of SCT is to allow suitable patients to be treated in the community rather than under detention in hospital, and to provide a way to help prevent relapse and any harm – to the patient or to others – that this might cause. It is intended to help patients to maintain stable mental health outside hospital and to promote recovery.” (C.o.P. 25.2)

7. What’s different ? SCT CTO Revoke Recall

8. SCT – key messages Treatment option for some patients strict criteria Patient discharged into community but can be recalled to hospital Conditions are there to set framework for successful community living : attending for examination getting treatment preventing risk of harm – to patient or others Good care planning essential to success

9. “Forced treatment in the community”? No treatment by force in the community (except in very rare emergency situations) If a patient with capacity refuses treatment, can’t be treated unless recalled to hospital If a patient lacks capacity force can’t be used to give treatment if the patient objects to it SOADs - “Part 4A” certificate – a second opinion certifying that treatment is appropriate – needed for all patients after first month of medicinal treatment

10. Your use of recall to hospital ? SCT patients can be recalled to hospital if: they need treatment in hospital there would be a risk of harm – to themselves or someone else – if they did not receive treatment Treatment in hospital falls under usual rules for detained patients, unless Part 4A certificate covers it If patient’s condition allows, can be discharged back into community within 72 hours

11. Your use of revocation ? If a recalled patient needs more treatment – beyond the 72 hour period - the community treatment order (CTO) can be revoked Revocation means patient detained again (Section 3, 6 month period start again) Responsible clinician and AMHP must agree that revocation is necessary or it cannot happen Patient can apply to the Tribunal and Hospital Managers

12. Safeguards for SCT patients • Experience of tribunal or hospital managers hearings ? • Discharge by nearest relative ? • Patient entitled to IMHA service since April

13. Table top work What is the impact of SCT in your service? What has been the impact of SCT on your own practice has it made any difference? What difference has it made for users and carers?

14. Thank you Malcolm King National Mental Health Development Unit Wellington House, 133-155 Waterloo Road, London SE1 8UG T: 020 7972 4803 www.nmhdu.org.uk