Opening the Floodgates? The Possible Use of Supervised Community Treatment in England and Wales
| Date | 01 March 2008 |
| DOI | https://doi.org/10.1108/13619322200800007 |
| Published date | 01 March 2008 |
| Pages | 41-43 |
| Author | Simon Lawton‐Smith |
| Subject Matter | Health & social care |
Abstract
The UK government’s Mental Health Act 2007 introduces compulsory supervised community treatment (SCT) to
England and Wales. Estimates of the possible level of use of SCT are helpful both to address patient fears and to plan
services. The number of patients under SCT is likely to rise over time, although the level of use will depend on a
number of contextual variables and whether evidence of clinical and social benefits is forthcoming.
Key words
Community treatment, legislation, Mental Health Act, hospital detention
Opening the Floodgates?
The Possible Use of Supervised
Community Treatment in
England and Wales
Mental Health Review Journal Volume 13 Issue 1 March 2008 © Pavilion Journals (Brighton) Ltd 41
PRACTICE
Simon Lawton-Smith
Senior Fellow, Mental Health, Kings Fund
SCT will be authorised by a patient’s responsible
clinician (generally a psychiatrist) with the agreement
of an approved mental health professional (generally
a social worker), and will initially apply for six
months. It can be renewed for a further six months
and then annually.Patients may appeal to the Mental
Health Review Tribunal against the decision to be
placed under SCT.
How many patients may be
affected?
There are two main reasons for wanting to know
how many patients may be placed under SCT. The
first is to help to address the high levels of concern
expressed by mental health service users, many of
whom are genuinely frightened of the possible
impact on their lives. The second is to help
commissioners and service providers to plan
for the arrival of SCT.
The King’s Fund has estimated that over a period of
10 to 15 years the number of patients subject to CTOs
in England and Wales might rise to between 7,800
and 13,000 at any one time (Lawton-Smith, 2005).
This estimate was based on the use of existing
community powers in the Mental Health Act 1983,
namely guardianship, supervised aftercare and leave
of absence, and a study of international use of CTOs
On July 19 2007 Royal Assent was granted to the
Mental Health Act 2007, covering England and Wales.
The Act amends the Mental Health Act 1983 and is
expected to come into effect in the autumn of 2008.
One of the most controversial aspects of the 2007
Act is the introduction of supervised community
treatment (SCT). Under SCT, patients who have been
compulsorily detained in hospital for treatment may,
on discharge, become subject to a community
treatment order (CTO) requiring them to comply
with certain conditions, including taking their
medication. Unlike existing supervised aftercare
powers in the 1983 Act, SCT will allow a non-
compliant patient to be conveyed to hospital for
compulsory treatment in effect as an outpatient,
without the necessity of formal re-sectioning.
SCT aims to break the ’revolving door’ cycle
of those patients who fail to comply with their
treatment when in the community and who
experience repeated admissions to hospital
(Department of Health, 2006a).However, the 2007
Act allows patients to be discharged under SCT after
their first compulsory admission for treatment, so
a history of previous hospitalisation is not necessary.
SCT also aims to allow earlier discharge from
hospital (though not from compulsory treatment)
to facilitate patients’ social inclusion.
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