Mental Welfare Commission also highlights good practice
By Ian Birch
In its first review of the legislation, a Scottish watchdog has said Community Compulsory Treatment Orders (CCTOs) have been effective over the past two years but there is much scope for improvement.
CCTOs were introduced in Scotland under the Mental Health (Care and Treatment) (Scotland) Act 2003 to give psychiatrists and community mental health teams the powers to treat people with severe mental illnesses in the community without having to be hospitalised.
Before the 2003 Act was implemented, there were no provisions for compulsory treatment in the community, except under “leave of absence” from hospital, which was allowed by the Mental Health (Scotland) Act (1984).
The Mental Welfare Commission Scotland (MWCS) interviewed around 200 patients on CCTOs in the country, most of whom were taking compulsory medication. It found that many people disagreed with the medication they were forced to take, some treatment was being given illegally, few people had advance statements, most people subject to CCTOs were not receiving the required regular physical health check-ups, and some people hadn’t had regular enough reviews of the grounds for compulsion. In addition, very few people were in paid or voluntary work.
The MWCS makes a number of key recommendations for improving CCTOs in Scotland:
- Care should be co-ordinated even where there is no care co-ordinator
- Services should offer a choice of ways to involve patients in decisions about their care
- Practitioners and service managers must ensure that treatment is administered lawfully
- People should be advised to make advance statements upon hospital discharge if possible
- NHS boards must comply with requirements to ensure regular physical health check-ups
- Care pathway plans must have a “revocation strategy” i.e. when a patient recovers enough to no longer need compulsory treatment
- Managers should ensure a “social circumstances report” is updated annually
- Councils and NHS boards should work closely with housing providers to ensure good accommodation appropriate to patients’ needs
- Accommodation and support needs should regularly be reviewed to ensure people can move on from intensively supported housing to mainstream accommodation with support
- Councils should comply with sections 25-31 of the Mental Health Act regarding education and employment opportunities for patients
- Care plans should cover employment and other meaningful occupation as a key theme of recovery
A worrying finding is the difference across Scotland in the use of care plans (CPA). The MWCS report shows that:
- Almost everyone in Fife and Forth Valley was on CPA
- In Lothian only 6 people (15%) were on CPA
- In Dumfries and Galloway no-one on a CCTO was on CPA
The MWCS says “NHS Boards that are low users of CPA must make sure that care and support is well co-ordinated in other ways”. But it found that 95% of care plans were of a high standard and appropriate to the patients’ needs.
