Guardianship under the Mental Health Act 1983

Aims and MethodTo describe the extent and variation in the use of Guardianship nationally. The Directors of Social Services were asked to provide details about Guardianship cases on two separate occasions one year apart.ResultsThere were 428 new Guardianship cases in 12 months. At the second enumeration, 73% of cases were within the mental illness category and 47% of these had serious mental illness.Clinical ImplicationsThere is much variation in the use of Guardianship. Further developments of this study will explore the reasons for this variation and will ascertain clinicians' views on Guardianship, supervised discharge and other community treatment orders.

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Community treatment orders and the experiences of ethnic minority individuals diagnosed with serious mental illness in the Canadian mental health system

International Journal for Equity in Health ◽

10.1186/s12939-014-0069-3 ◽

2014 ◽

Vol 13 (1) ◽

Cited By ~ 8

Author(s):

Magnus Mfoafo-M’Carthy

Keyword(s):

Mental Health ◽

Mental Illness ◽

Health System ◽

Ethnic Minority ◽

Serious Mental Illness ◽

Mental Health System ◽

Community Treatment ◽

Community Treatment Orders

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This strange republic of the good: Community treatment orders and their conditions

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i21.226 ◽

2014 ◽

pp. 39 ◽

Cited By ~ 1

Author(s):

David Hewitt

Keyword(s):

Mental Health ◽

Health Professional ◽

Mental Health Professional ◽

Community Treatment ◽

Community Treatment Orders ◽

Mental Health Act ◽

Treatment Order ◽

Community Treatment Order

The Community Treatment Order (CTO) was introduced by the Mental Health Act 2007, and from the start, it was controversial. There is evidence that even the principle of community compulsion was opposed by a majority of psychiatrists, and it was said that many would resign rather than implement CTOs. Happily, that prediction has not been realised. In fact, it seems that many psychiatrists, and more than one Approved Mental Health Professional (AMHP), have seized upon CTOs with something approaching alacrity.

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Impact of introducing capacity-based mental health legislation on the use of community treatment orders in Norway: case registry study

BJPsych Open ◽

10.1192/bjo.2021.1073 ◽

2022 ◽

Vol 8 (1) ◽

Author(s):

Georg Høyer ◽

Olav Nyttingnes ◽

Jorun Rugkåsa ◽

Ekaterina Sharashova ◽

Tone Breines Simonsen ◽

...

Keyword(s):

Mental Health ◽

Incidence Rates ◽

Community Treatment ◽

Prevalence Rates ◽

Community Treatment Orders ◽

Retrospective Case ◽

Case Register ◽

Mental Health Act ◽

Catchment Areas ◽

Involuntary Care

Background In 2017, a capacity-based criterion was added to the Norwegian Mental Health Act, stating that those with capacity to consent to treatment cannot be subjected to involuntary care unless there is risk to themselves or others. This was expected to reduce incidence and prevalence rates, and the duration of episodes of involuntary care, in particular regarding community treatment orders (CTOs). Aims The aim was to investigate whether the capacity-based criterion had the expected impact on the use of CTOs. Method This retrospective case register study included two catchment areas serving 16% of the Norwegian population (aged ≥18). In total, 760 patients subject to 921 CTOs between 1 January 2015 and 31 December 2019 were included to compare the use of CTOs 2 years before and 2 years after the legal reform. Results CTO incidence rates and duration did not change after the reform, whereas prevalence rates were significantly reduced. This was explained by a sharp increase in termination of CTOs in the year of the reform, after which it reduced and settled on a slightly higher leven than before the reform. We found an unexpected significant increase in the use of involuntary treatment orders for patients on CTOs after the reform. Conclusions The expected impact on CTO use of introducing a capacity-based criterion in the Norwegian Mental Health Act was not confirmed by our study. Given the existing challenges related to defining and assessing decision-making capacity, studies examining the validity of capacity assessments and their impact on the use of coercion in clinical practice are urgently needed.

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Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study

BMJ Open ◽

10.1136/bmjopen-2019-035121 ◽

2020 ◽

Vol 10 (3) ◽

pp. e035121 ◽

Cited By ~ 4

Author(s):

Wikus Barkhuizen ◽

Alexis E Cullen ◽

Hitesh Shetty ◽

Megan Pritchard ◽

Robert Stewart ◽

...

Keyword(s):

Mental Health ◽

Mortality Rate ◽

Psychiatric Hospital ◽

Mental Healthcare ◽

Index Admission ◽

Community Treatment ◽

Lower Mortality ◽

Community Treatment Orders ◽

Electronic Health Record Data ◽

Mental Health Act

ObjectivesLimited evidence is available regarding the effect of community treatment orders (CTOs) on mortality and readmission to psychiatric hospital. We compared clinical outcomes between patients placed on CTOs to a control group of patients discharged to voluntary community mental healthcare.Design and settingAn observational study using deidentified electronic health record data from inpatients receiving mental healthcare in South London using the Clinical Record Interactive Search (CRIS) system. Data from patients discharged between November 2008 and May 2014 from compulsory inpatient treatment under the Mental Health Act were analysed.Participants830 participants discharged on a CTO (mean age 40 years; 63% male) and 3659 control participants discharged without a CTO (mean age 42 years; 53% male).Outcome measuresThe number of days spent in the community until readmission, the number of days spent in inpatient care in the 2 years prior to and the 2 years following the index admission and mortality.ResultsThe mean duration of a CTO was 3.2 years. Patients receiving care from forensic psychiatry services were five times more likely and patients receiving a long-acting injectable antipsychotic were twice as likely to be placed on a CTO. There was a significant association between CTO receipt and readmission in adjusted models (HR: 1.60, 95% CI 1.42 to 1.80, p<0.001). Compared with controls, patients on a CTO spent 17.3 additional days (95% CI 4.0 to 30.6, p=0.011) in a psychiatric hospital in the 2 years following index admission and had a lower mortality rate (HR: 0.66, 95% CI 0.50 to 0.88, p=0.004).ConclusionsMany patients spent longer on CTOs than initially anticipated by policymakers. Those on CTOs are readmitted sooner, spend more time in hospital and have a lower mortality rate. These findings merit consideration in future amendments to the UK Mental Health Act.

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Personality disorder and the Mental Health Act 1983 (amended)

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.109.006841 ◽

2010 ◽

Vol 16 (5) ◽

pp. 329-335

Author(s):

Piyal Sen ◽

Ashley Irons

Keyword(s):

Mental Health ◽

Personality Disorder ◽

Community Treatment ◽

The Political ◽

Specific Reference ◽

Political Climate ◽

Community Treatment Orders ◽

Usual Practice ◽

Mental Health Act ◽

Definition Of

SummaryThe Mental Health Act 1983 now incorporates amendments introduced in 2007. This article explores features of the amended Act that affect the treatment of patients with personality disorder in England and Wales. It discusses issues such as the broad definition of mental disorder, treatability and professional roles, with specific reference to how they might, or might not, affect usual practice concerning patients with personality disorder. It also comments on elements within the Act that could positively affect people with personality disorder, such as community treatment orders, provision to change their ‘nearest relative’ and statutory advocacy services. The political climate in which the Act has been amended is commented on, as well as how this might potentially compromise some of the positives within the Act.

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Community treatment orders in England: review of usage from national data

BJPsych Bulletin ◽

10.1192/bjb.2017.33 ◽

2018 ◽

Vol 42 (3) ◽

pp. 119-122 ◽

Cited By ~ 5

Author(s):

Susham Gupta ◽

Elvan U. Akyuz ◽

Toby Baldwin ◽

David Curtis

Keyword(s):

Mental Health ◽

Service Provision ◽

Psychiatric Service ◽

Community Treatment ◽

Clinical Implications ◽

Economic Downturn ◽

National Data ◽

Community Treatment Orders ◽

England And Wales ◽

Low Rate

Aims and methodCommunity treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England.ResultsAbout 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation. The low rate of CTO discharges by mental health tribunals (below 5%) suggests that they are not used inappropriately.Clinical implicationsThe introduction of CTOs in England has coincided with a reduction in psychiatric service provision due to the economic downturn. Pressures on services might be even more severe if patients currently subject to CTOs instead needed to be detained as in-patients.Declaration of interestNone.

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The Mental Health Act 1983

Psychiatric Bulletin ◽

10.1192/pb.23.9.534 ◽

1999 ◽

Vol 23 (9) ◽

pp. 534-536 ◽

Cited By ~ 2

Author(s):

Vijay Bhatti ◽

Jeremy Kenney-Herbert ◽

Rosemarie Cope ◽

Martin Humphreys

Keyword(s):

Mental Health ◽

Mental Illness ◽

Clinical Practice ◽

Random Sample ◽

Clinical Implications ◽

The West ◽

Mental Health Act ◽

West Midlands

Aims and methodA one-in-five random sample (n=104) of practitioners approved under Section 12(2) of the Mental Health Act 1983 in the West Midlands was selected. Opinions were sought on issues relating to current law and potential reform.ResultsEighty-three (80%) doctors were interviewed. Over half (52%) stated that the term ‘mental illness' in the Act was unsatisfactory. Two-thirds (68%) specified the need for a review of legislation relating to treatment in the community.Clinical implicationsThere was a diversity of views. This is likely to be reflected in the clinical practice of those interviewed. Many respondents believed that there was a need for reform in specific areas of the Act.

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Clinical stability in the community associated with long-term approved leave under the Mental Health Act 2001

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2014.19 ◽

2014 ◽

Vol 31 (2) ◽

pp. 143-148 ◽

Cited By ~ 1

Author(s):

E. Bainbridge ◽

F. Byrne ◽

B. Hallahan ◽

C. McDonald

Keyword(s):

Mental Health ◽

Case Report ◽

Community Treatment ◽

Residential Setting ◽

Community Treatment Orders ◽

Psychotic Illness ◽

Persistent Symptoms ◽

Mental Health Act ◽

Clinical Stability

IntroductionWe present the case of a 27-year-old man with a background diagnosis of treatment resistant schizophrenia and absent insight who for the last 3 years has been residing in a high support residential setting on approved leave under the Mental Health Act (MHA) 2001. The case demonstrates how this man achieved clinical stability in the community with the assistance of long-term involuntary admission under the MHA 2001, in contrast to the previous years of his illness in which he had suffered multiple relapses of his psychotic illness with ssociated distress, poor self-care and repeated in-patient re-admissions. We discuss the equivalent use of community treatment orders in other jurisdictions and how the judicious use of approved leave under the MHA 2001 may be used as an alternative in Ireland where community treatment orders are not currently available.MethodCase Report.ConclusionThe case report highlights how the use of long-term approved leave under the MHA2001 may be used as alternative in Ireland to mimic CTOs for certain difficult to treat patients with psychotic illness who would benefit from ongoing treatment, but lack capacity to engage in such treatment due to persistent symptoms and lack of insight.

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Competency and use of the Mental Health Act – a matrix to aid decision-making

Psychiatric Bulletin ◽

10.1192/pb.26.3.104 ◽

2002 ◽

Vol 26 (3) ◽

pp. 104-106

Author(s):

Jacinta Tan ◽

Martin Elphick

Keyword(s):

Mental Health ◽

Decision Making ◽

Mental Illness ◽

Good Practice ◽

Clinical Situation ◽

Clinical Implications ◽

Clear Understanding ◽

Mental Health Act ◽

Aid Decision

Aims and MethodCompetence in patients with mental illness is an issue of growing importance. We present a matrix that provides a new tool to separate the elements involved.ResultsThis matrix is compatible with, and makes explicit, the Richardson Committee's suggestions concerning the incorporation of a test of capacity in Mental Health Act assessments.Clinical ImplicationsWe suggest that use of this matrix may offer practical help to clinicians in arriving at a clear understanding of each clinical situation and guide good practice in the use of the Mental Health Act, particularly in problematic cases.

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