CTO Patients in Prison

When a patient is subject to a CTO but then they are placed in prison are they still subject to the CTO? If so, who is responsible for their care such as consent to treatment and renewals?

Hi there. Please see Section 22.

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Hi, I have copied the relevant paragraphs from the MHA Reference guide:

26.98 Special rules apply to CTO patients who are imprisoned, remanded or otherwise detained in custody by any court in the UK. These are similar to those for part 2 detained patients.

26.99 Such patients automatically cease to be CTO patients if they remain in custody for longer than six months in total.

26.100 Until then, they formally remain CTO patients, unless discharged from their CTO in the interim. If they are released from custody during that six month period, they are treated as if they had gone AWOL on the day of their release.

26.101 Because patients in this situation are treated as being AWOL, if such a patient’s CTO would otherwise have expired, or is about to expire, it will not in fact expire until the end of the week starting with the day of the patient’s return to hospital (if the patient had already been recalled to hospital when first imprisoned) or (if not) the date of the patient’s release from custody.

26.102 The effect of this is that, if the patient’s CTO is otherwise due to expire, responsible clinicians will always have at least a week in which to examine the patient and submit a report extending the CTO, if appropriate, under section 20A.

26.103 Although CTO patients released from custody after less than six months are treated as having gone AWOL, they may only automatically be taken into custody and returned to a hospital if they had already been recalled to that hospital when they were first imprisoned. Even then, that can only be done during the 28 day period starting with the date of their release.

26.104 The normal rules about recalling patients to hospital apply to patients released from custody during whatever period remains of their CTO (including the one week extension, where relevant). They can, if necessary, be recalled to hospital in order to be examined with a view to making a report extending their CTOs (see paragraph 26.33). If they failed to attend, they would be considered AWOL in the normal way, and could therefore be taken into custody at any time during the six months starting with the day they failed to attend, as described in paragraphs 26.68 onward.

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Thank you for this i am little confused as to where we would stand in terms of this patients expiry, he has not been in custody for more than 6 months and his section is due to expire on 23/08/2022. if he is only deemed to be awol on the day of release what happens during this period of time when the section expires while the patient is still in custody.

The title of the part of the Reference Guide quoted above is "Patients who are imprisoned etc [section 22, read with sections 18, 21 and 21A] ", so you could look at s18, s21 and s21A as well as s22.

Section 22 covers two relevant scenarios, with similar outcomes. First, if the patient is detained in custody for a period greater than six months, the CTO ends when that period ends (s22(1)-(3)). Secondly, if the patient is detained in custody for a period up to six months, and the CTO would ordinarily have ended during that detention (e.g. your patient on 23/8/22), then it ends instead at the end of the release date (s22(4)-(5)).

I think if the patient is detained for up to six months but the CTO is not due to expire until after release, it just carries on.

The subsections treating the patient as having gone AWOL on the date of release and having returned 28 days later (s22(6)-(8)) seem to be intended to give extra time (7 days after the 28 days) to renew the CTO if its ordinary expiry date is on or within a week after the release date. I’ve not quite got my head round it, but it might not be relevant to your case anyway!