Report raises concerns over use of community treatment orders


More than 14 times as many community treatment orders (CTOs) have been issued to people with mental health problems than the Department of Health predicted, according to the care and health inspectorate.
The concerns were raised in the final biennial report from the old Mental Health Act Commission (MHAC) – issued by the new Care Quality Commission (CQC) which took over its duties in April.
The CQC said 2, 868 orders had been issued by the end of June 2009, compared with a prediction of just 200 by the end of their first year of operation in three months’ time.
The commission said it was concerned at the shortage of information about how the controversial orders were being used since coming into force last November.
CTOs were designed to treat people in the community, and so avoid compulsory detention in hospital, but campaigners warned during the government’s battle to force through its Mental Health Act in 2007 that they could be overused.
The report also says there could be an even higher over-representation of people from black and ethnic minorities among those issued with CTOs than among those detained in hospital.
The CQC said the numbers of CTOs issued had put a “strain” on the system and led to delays by the appointed doctors who review their care and treatment plans. It is now trying to recruit more doctors.
The report on the treatment of people detained under the Mental Health Act in England also says nearly three in ten acute wards are running at more than 100 per cent occupancy.
And it says there is an increasing trend towards the use of locked wards in acute care, with a need for more patient choice and therapeutic activity.
It also finds “worrying” evidence of untrained staff using restraint procedures, with three inquests into patient deaths during 2008 partly blaming a lack of staff training.
The report also says six patients who were supposed to have been under continuous observation have died by hanging or self-strangulation since 2005.
And it says nearly a quarter of a sample of 500 detained people had not received information they were entitled to about their rights and treatment.
The mental health charity Mind said the report was “shocking” and revealed “shameful” conditions in many wards, with “entrenched” poor practice, and overstretched staff who “often lack the basic skills to prevent tragedies”.
21 July 2009