Use of community treatment orders for mental health patients rises 29% in a year

The number of people with mental health problems subject to community treatment orders in England has risen by almost a third in the past year, according to the Care Quality Commission.

The commission’s second annual report on the use of the Mental Health Act in England, Monitoring the Mental Health Act in 2010/11, said the number of people subject to the act was 5% higher than in the previous year—rising from 19 947 on 31 March 2010 to 20 938 on 31 March 2011.

This was mostly because of the use of community treatment orders, which were introduced in November 2008 as a way of enabling patients who are detained in hospital to be discharged into the community and receive their treatment there.

The number of people subject to a treatment order at the end of the year grew by 29.1% from 3325 people to 4291 people, even though fewer new orders were started this year.

The report says that this suggests that treatment order powers, once implemented, can last for some time and that the population subject to orders will continue to grow.

The commission is responsible for protecting the interests of people who are subject to the Mental Health Act, by monitoring how mental health services in England (both NHS and independent sector) are using their powers and fulfilling their duties for patients who are detained in hospital or subject to community treatment orders or to guardianship.

In preparing the report, the commission’s mental health act commissioners met patients in private to discuss their experiences and concerns, made sure they understood their rights and checked that staff were using the act correctly.

In 2010-11 they made 1565 visits and met more than 4700 patients.

Overall, the commission concluded that, despite many examples of good practice, care for people treated under the Mental Health Act still needed to improve.

A lack of patient involvement in the care planning process was one of the issues most often reported by mental health act commissioners after visits to hospitals.

On many wards, there was little evidence that staff had attempted to ascertain the patients’ views and wishes, and there was little indication that patients had been given copies of their care plans.

On consent to treatment, the commission found that in some cases, doctors seemed to assume too readily that patients had the capacity to give their consent to treatment.

In addition, the legal powers available to providers in relation to community treatment orders were widely misunderstood, even among mental health professionals.

The commission also looked at restrictions imposed on patients in hospital and highlighted examples of poor or questionable practice, such as denying patients regular access to the internet, locking them out of their rooms during the day and listening to their telephone calls.

Commission chief executive Cynthia Bower said that the report reflected individual patients’ experiences: “The realties of care shown here vary from one NHS trust to another and in some cases from ward to ward.”

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