Application of community treatment orders (CTOs) in adults with intellectual disability and mental disorders
| Published date | 06 July 2015 |
| DOI | https://doi.org/10.1108/AMHID-02-2015-0007 |
| Date | 06 July 2015 |
| Pages | 196-205 |
| Author | Jaya Gupta,Angela Hassiotis,Ingrid Bohnen,Yogesh Thakker |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Application of community treatment orders
(CTOs) in adults with intellectual disability
and mental disorders
Jaya Gupta, Angela Hassiotis, Ingrid Bohnen and Yogesh Thakker
Dr Jaya Gupta is Specialist
Registrar at the Camden
Learning Disability Service,
Camden and Islington
Foundation Trust, London, UK.
Angela Hassiotis is Professor at
the Division of Psychiatry,
University College London,
London, UK and Camden &
Islington NHS Foundation
Trust, London, UK.
Dr Ingrid Bohnen is Community
Consultant Psychiatrist and
Dr Yogesh Thakker is
Consultant Psychiatrist, both
at the Westminster Learning
Disability Partnership, Central
and North West London NHS
Foundation Trust, London, UK.
Abstract
Purpose –The purpose of this paper is to explore use of community treatment orders (CTOs) in adults with
intellectual disability (ID) and mental health problems across England and Wales.
Design/methodology/approach –A web-based exploratory survey was sent to 359 consultants on the
database of the Faculty of the Psychiatry of ID, Royal College of Psychiatrists who had declared ID as their
main speciality. Socio-demographic details of responding consultants, clinical characteristics of adults with
ID on CTO, subjective views of consultants on using CTOs in people with ID were collected and analysed.
Findings –In total, 94 consultant questionnaires were returned providing information on 115 patients
detainedunder CTO. More than 75per cent of the respondentshad used CTO in their clinicalpractice. Patients
subject to CTO were generally young, white males with mild ID and living in supported accommodation.
CTOs were primarily usedin situations of non-engagement (52.2 per cent), non-compliance with medication
(47 per cent) or non-compliance with social care supports(49.6 per cent).
Practical implications –Responding consultants expressed concerns about encroachment of civil liberties
and ethics of using CTOs in people with ID who may lack capacity and stressed that decision to use CTOs
needs to be therefore done on individual basis.
Originality/value –This is the first national study to examine the practice of applying CTOs in adults with ID
and mental disorders. Current practice is based on evidence from research done in adults with normal
intelligence. Further research is needed to investigate the utility of CTOs in routine clinical practice in adults
with ID and mental disorders.
Keywords Intellectual disability, Learning disability, Mental health act, Community treatment orders, CTO,
Guardianship
Paper type Research paper
Introduction
It is estimated that about 1.14 million people in England have intellectual disability (ID) (Emerson,
2013). Mental disorders of any type have been found in up to 40 per cent of adults with ID living in
the community (Deb et al., 2001; Cooper et al., 2007; Morgan et al., 2008). Historically, people
with ID and mental health disorders were admitted to long-stay hospitals. Government policies,
the process of deinstitutionalisation and the development of a range of community services
resulted in an increase in focus on community ID teams providing a range of services, including
those for mental ill health and behaviour that challenges (Lindsey, 2000; Kingdon, 2005).
Community orders have been applied in the UK under the Mental Health Act 1983 for the
patients with severe mental illness presenting with difficulties in treatment adherence and
engagement with services. Supervised Discharge (Section 25) and Guardianship (Section 7)
Received 12 February 2015
Revised 11 May 2015
Accepted 12 May 2015
PAG E 19 6
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 9 NO. 4 2015, pp. 196-205, © Emerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-02-2015-0007
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