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Time To Review The Mental Health Act


Data from the Information Centre for Health and Social Care shows that compulsory mental health treatment for people in community settings has risen for the third successive year since the powers were introduced. Worryingly, data for 2010-11 shows an increase of 10% on the previous year. Whether this is a good thing or a bad thing depends on your perspective. While some argue that more and more patients are being deprived of their liberty without proper safeguards, others claim that CTOs allow people who would otherwise be detained in hospital receive support in their own homes.


Before taking a position on this, it's worth looking back at the history of CTOs. Something similar was proposed in the early 1990s following the NHS & Community Care Act, which accellerated the process of decanting mental health services from hospitals into the community. Many argued that the pace had been too fast, and that people were being 'lost'. The first response was the introduction of 'supervision registers' for those deemed 'at risk'. These were criticised by professionals as being unethical, and found by a later review to have been ineffective. The next effort was the Mental Health (Patients in the Community) Act of 1995 which gave professionals the power to convey people to hospital for treatment, but not to treat them at home. Again rejected as impractical by professionals, these powers were not widely used.


By the time New Labour were elected in 1997 there had been a spate of 'community care killings' - homicides by people with a mental illness spuriously linked to the community care policy by the tabloid press. The incoming government promised to 'get tough',  launching a Green Paper subtitled 'Safe, Sound and Supportive' - apparently listing their priorities in order. When the following White Paper was finally published in 1999, it contained two sets of controversial proposals. The first related to CTOs, whilst the second proposed provision for the indefinite detention of people with 'Dangerous and Severe Personality Disorder.'


The proposals were so unpopular with professionals and patients' righjts groups that they resulted in a national Mental Health Alliance that fought them effectively for a further eight years.  By 2008, though, a new Mental Health Act had been passed and both of the controversial proposals were in force (although DSPD was limited to people who had already been convicted of offences, and CTOs were restricted to those who had already been hospitalised).


Four years on and DSPD services have been widely criticised as a failure. The main concern at the time - that potentially dangerous prisoners would be 'warehoused' for long periods with little access to effective treatment - has been borne out. But have CTOs also failed?


With CTOs the situation was always very different: the aim was not to manage 'dangerous' patients, but to prevent people from becoming unwell as a result of 'non-compliance' with treatment. While there was a discourse about 'managing risk' there was a counter-argument that CTOs would allow treatment in a less restrictive setting. What few foresaw was that pressure on hospital beds would have continued to soar, making CTOs even more attractive for bed managers looking to shunt patients into less expensive community settings whilst retaining the power to bring them back quickly if things don't work out. The real concern here is that once people are out of hospital and 'stable' in the community, there is little incentive for Psychiatrists to discharge patients from their 'section'. In other words, the numbner of hospital beds used to put a 'lid' on the number of people who could be subjected to copulsory powers, but CTOs have taken the lid off.


With 4,200 people now on CTOs and a record 48,600 people treated under the Act in 2011-12, it's now time to go back to the legislation and ask whether it's out of control.


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