Mental Health Act community treatments orders – focused visits report

Today (1 November) we have published the findings from a series of focused visits to explore how community treatment orders (CTOs) were being used in 9 boroughs across London between February 2019 and November 2021.

The report shares the findings of our review, highlights key areas of concern, and makes recommendations for providers and partners. In June 2022, the government published its proposed changes to CTOs as part of the draft Mental Health Bill. The amendments to the bill aim to tighten the criteria for CTOs and we support the intention of CTO use only where there is strong justification to do so. However, more work needs to be done by health and social care systems to improve work with local community services, to ensure disproportionate use and racial disparities of CTOs are effectively reduced.

During these focused visits, we found that some patients appreciated the benefits of being on a CTO and most community mental health teams closely supervised patients on CTOs. If a patient needed to be recalled to hospital, most boroughs told us that this would generally happen quickly and was not affected by bed shortages.

However, there are some fundamental issues around the use of CTOs, for example:

  • the disproportionate impact on Black patients
  • the family and patient involvement in CTOs varies
  • in some cases CTOs had been active for several years, with the patient not knowing how they could be taken off the CTO.

We make a number of recommendations, including encouraging providers to:

  • monitor, investigate and take steps to reduce the number of Black patients currently on CTOs
  • ensure CTO care plans are accurate, comprehensive and up to date.

Chris Dzikiti, Director of mental health at CQC said:

“It is a real concern that our review found some community treatment orders (CTOs) were being used in an overly restrictive way and could lead to people experiencing health inequalities. More needs to be done to reduce the overall use of CTOs and disproportionate effect on Black patients.

“The changes to the draft Mental Health Bill, published in June 2022, are in line with some of our concerns. We support the amendments’ aim to tighten the criteria for CTOs and its intention of their use being only where there is strong justification but this is only a start.

“The disproportionate number of Black people and people from some ethnic minority groups detained under the MHA and subject to CTO is unacceptable and more needs to be done by systems working with local people and communities to change this. Areas such as culturally appropriate advocacy and the Patient and Carer Race Equality Framework (PCREF) pilots are showing some positive signs but there is much more to do.”

by Wendy
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