Patient with diagnosis of chronic longstanding resistant schizoaffective disorder discharged on CTO from hospital recently on oral antipsychotic medication . P stopped medications and was AWOL briefly and engaged with CPN only once. The 1 month period to assess capacity for consent to treatment will end soon. P did not attend clinic - mandatory CTO criteria. P has long standing continous psychosis and no where near to the point that he needs a CTO recall to hospital admission now ,. What do i do wiwth consent to treatment if he does not see me? any advice will be great
Legally, you can recall them just to carry out the assessment.
Failure to comply with the mandatory condition is, by itself, grounds for recall, whether or not the patient meets the general grounds for recall - see s17E(2) of the Act and para 29.47 of the (English) Code of Practice. That was included in the Act precisely for this situation.
If they don’t attend when recalled, they’re AWOL and can be made to attend. No need to admit them or have a bed available (unless they need it) - the idea is they come (willingly or not), you assess, you release them.
Thanks. I was thinking precisely on the same grounds but what if the 1 month time for consent to treatment runs out? As even on recall P fails to attend . Where do we legally stand
Once the one month period is up then it would be unlawful to give the patient any further psychiatric medication until you managed to get a certificate in place, unless (as Zac says) one of the exceptions for immediately necessary treatment applies.
In practice, those exceptions won’t help you with a patient who has capacity and is refusing consent - because you’d still have to successfully recall them to hospital (though not necessarily readmit them) before you could make use of the exceptions in s62. (The exceptions in s64G are only for patients who lack capacity, and the one in s64B(3)(b) only for patients who can and do consent).
But - and apologies if I’m missing something obvious - in practice is that going to make amy difference ? If the patient is avoiding all contact, how would you give them any more medication before you could see them ?
thanks so much Richard and Zac, There is no urgent need ie Sec 64 G . P lacks capacity on a balance of probability. He may also not attend SOAD if i ask for it. . P lacks insight and there is evidence P has stopped his antipsychotic. there is no urgency as such as P has continuing psychosis no well interval as such . No immediate recall tox hospital is needed. i plan to recall him to my clinic which he will not pay any heed. so do i just wait till time i need to recall him to hospital
I’m not a clinician, but it doesn’t sound right to me to let treatment decisions effectively be dictated by practical problems in getting a SOAD certificate. If he needs the medication, shouldn’t an attempt be made to make that happen ?
If you recall him and he doesn’t show up, you can use the AWOL powers in s18 to have him brought against his will to a SOAD appointment (or indeed an outpatient clinic appointment), provided it takes place in a hospital.
I appreciate that might take a bit of arranging in practice. But just letting things ride until his condition worsens to the point of needing readmission to hospital (if that’s what you’re expecting to happen) seems to defeat the purpose of him being on a CTO in the first place.