what are the views of using CTO to to demands patient to reside at a particular residential home, the patient has capacity and diagnosed with EUPD
CTO is fundamentally about treatment, not residence.
If requirement to reside is relevant, then guardianship could be considered, although neither CTO nor guardianship would authorise restrictions which amount to a deprivation of liberty, and if the person has capacity (regarding their accommodation), neither will the MCA through the DoLS process.
I agree with SteveC.
CTO conditions (other than the statutory ones) aren’t enforceable - if the patient decided to go and reside somewhere else, this in itself wouldn’t trigger recall; the RC would have to consider whether leaving the accommodation was either a sign of relapse or a high risk behaviour (Code of Practice 25.26 and 29.45)
Thanks that it is my view, as as it is written on the tin " it is a Treatment order"
a inpatient consultant want this to happen and as the community R/C i object to accept for the above mentioned reason
A CTO needs to be agreed by an AMHP. I think the AMHP would need to be asking some very searching questions about the reason why a CTO is being requested if the main intention is to require a place of residence. The recall power is to hospital, not to the place of residence. The other question to ask is what specific treatment will be provided under CTO for someone with this diagnosis. And why can the traditional elements of the MHA (s2, s3) not be relied upon in the event of deteriorating mental state?
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In relation to ‘the patient has capacity’ I presume that this is in relation to care and accommodation. Just in case it is relevant to the facts of your case there is very helpful guidance that looks at situations where P’s capacity fluctuates and how to approach these situations in practice. I would highlight in particular:
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Mental Capacity Guidance Note Fluctuating Capacity in Context December 2021
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Mental Capacity Guidance Note: Assessment and Recording of Capacity | 39 Essex Chambers and
Apologies if not relevant, but thought I would share in case that it was.
I know this forum is concerned with Mental Health Law, but we also need to consider how it’s used to inform practice. As stated above, a CTO cannot be used direct someone’s residence.
In practice Guardianship is only as good as the willingness of the Police to return someone to the required place. Police could soon loose patience if they are asked to return a person for the third or fourth time.
I would only consider Guardianship as a form of persuasion, and the question to be asked, is Guardianship in of itself enough to influence a person’s decision to agree to remain in a specific place. In this case, that influence will also likely need to consider whether or not this influence could be sustained as the person becomes distressed and dysregulates.
If I was the AMHP in this case, I would encourage the RC to first consider a period of extended Section 17 leave. This could be used to inform the decision making re the potential need of a Guardianship. If the person is able to form meaningful relationships with staff, and this relational security goes someway towards mitigating risks to self, others, health, then all well and good. If things go ‘pear shaped’, then back to Plan B, C, D etc