Memorandum submitted by Dr Angus Bell (MH 63)
I am personally supportive of the Bill but have serious concerns over the Lords amendments (restrictions) to the Community Treatment order. The Mental Capacity act rightly has enshrined within it the principle that people lacking capacity should be treated in the least restrictive environment possible, which is a central philosophy for those of us leading and developing community based mental health services. Least restrictive means in my view "at home" and not unnecessarily in hospital! Given that a CTO is going to apply to people who have demonstrated impaired capacity, and in the light of the "hospital at home" home treatment services that we have nowadays, why do we have to admit to a hospital and have a history of two previous admissions? This surely contravenes the above principles? By all means apply the CTO to well known and assessed patients with demonstrable histories of acute relapse but these days a modern service treats as far as possible in the community and to insist on what would be 3 hospital admissions is frankly out of touch with current developments. The CTO should apply to Section 3 patients with a history of relapse due to non-compliance only! Fears of overuse of a CTO should be addressed thro training and Code of practice not through restricting it so much as to reduce its major benefit.
The Mental health act has always applied to more people than it is used for the detained population are always less than the detainable population and this will continue as we seek to treat in the least restrictive way. Please consider the fact that in the future the types of people in hospital will be more ill and more specialised in terms of challenging behaviour, so if a genuine CTO is available it could support the revolution that is occurring in Adult services! Treat at home where possible.
 Clinical Director, Tees Esk and Wear Valleys Trust