Community treatment orders and nearest relative rules face axe under new Mental Health Act

Unpopular 'nearest relative' rules and community treatment orders look set to disappear after the Mental Health Act review team commissioned by the government published their provisional findings today.

Professor Simon Wessely's team have shared a 59-page update on the work they have led since their appointment by Prime Minister Theresa May last autumn.

• BAME fears of disappearing into a 'black hole' are genuine concerns - exclusive interview with Steven Gilbert, Mental Health Act review team vice-chair

The review has involved consultation with over 2,000 people who have been detained under the Mental Health Act.

Around half said they felt detention was the wrong approach to restoring their mental health.

The balance of respondents indicated they felt enforced care saved their life.

• Join the In Our Right Mind campaign to reform the Mental Health Act

An overwhelming majority said they were treated with a lack of dignity or respect, values that the review team say will drive continuing work that will conclude by the end of the year.

"We are clear, even at this early stage, that change is necessary [to] community treatment orders and the nearest relative provision," the review team write in today's report.

What are Community Treatment Orders?

Community Treatment Orders (CTOs) were introduced in 2007 amendments to the Mental Health Act as a form of supervised community treatment for people who have been detained to allow individuals to be safely treated in the community rather than in hospital.

However, studies have indicated that they do not reduce readmission rates and many of the 5,000 people currently compelled to receive ongoing medication in England find the practice oppressive and untherapeutic.

Today's report suggest CTOs are applied to black patients nine times more frequently than white patients, perhaps indicating structural racism. 

Reform of the nearest relative hierarchy is also on the cards, a cause that Mental Health Today campaigns on.

People who have been detained under the Act say it often leads to relatives with conflicting values having an unwanted overarching say in their care.

A survey of several hundred Mental Health Today readers showed clear backing for individuals to be able to choose which relative can exert an influence in their care plans when they are too distressed.

"Mental illness caused me to become very paranoid and very unsure as to who I could trust," Karen Manton, who was detained several times before recovering, told MHT. "As I was going through a divorce, I would have chosen someone who I felt would have my best interest at heart to advocate for me, not necessarily my next of kin.”

In an interview coinciding with today's report publication, Professor Simon Wessley told Mental Health Today "changes to the way capacity is being judged in crisis care now, compared to when I last worked in it, have been the biggest surprise for me in the review so far."

"Demands on services have become so acute that it's changed the way capacity is being evaluated now."

Having narrowed their focus, the review team will now consult further before producing finalised recommendations by the end of the year to guide the construction of a new mental health act.

The following goals are published in today's report:

• Service users and carers being treated with dignity and respect
• Greater autonomy for people subject to mental health legislation
• Greater access to services for those that need them
• Making the least restrictive option appropriate to a person’s circumstances the default option
• Improved service user and carer wellbeing
• Service users and carers supported to be fully involved in treatment as possible
• Reduced disparities between groups with protected characteristics

Response

"We want to see a Mental Health Act that puts the person front and centre, ensuring they are listened to, informed and able to a have a real say in what is happening to them," said Danielle Hamm, Associate Director of Campaigns and Policy at Rethink Mental Illness.

"The review's interim report has clearly set out the need for change and it should be required reading for politicians, whose task now must be to commit to reform this important but outdated legislation.”

"At a time when mental health is so prominent in the political and social spheres, it is important to make the Mental Health Act and mental health services work better for everyone such as BAME groups, against whom the Act is known to be used disproportionately," said Kathy Roberts, Chief Executive of the Association of Mental Health Providers.

"The Act has been used when people are most ill, vulnerable, in need of help, and have to be detained against their will, and so, it is important that the review ensures that this is done in an environment that is helpful, therapeutic, and not at all disproportionate."

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