In a study by The National Institute of Health Research published in The Lancet in May this year, it was found that there was no reduction in hospital admissions which could justify Community Treatment Orders. The randomised controlled trial revealed that well co-ordinated services were the key to maintaining people in the community.

This mirrors our experience. Psychiatrists and care co-ordinators are justifying CTO’s on the basis that it is quicker and easier to readmit a patient by means of recall rather than gather the requisite team together for a MH assessment in the community. This seems to be a response to operational difficulties rather than risk assessments, a view reinforced by the regular observations in tribunal reports that a CTO assists MH teams to secure the services

needed by patients.

It seems that as community MH staff are increasingly overworked and under resourced, CTO’s are being used as enhanced s117 packages and driven by a need for MHA assessments to take place where and when convenient to the needs of MH team schedules.

When CTO’s were proposed there was strong opposition on the basis that conditions curtailing freedom were not justified by any significant benefit to the health of patients or the safety of the public. Here we now have objective evidence not only that those fears were valid but that dangerous under resourcing of Community Mental Health teams are being masked by the use of CTO’s.

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