Hi, if a patient has a forensic history, would it be possible to make one of the conditions of the CTO about where he can or can’t live. Or does it have to be all about the treatment / medication compliance.
Many thanks
Hi, as far as I’m aware, you can’t make a place of residence a condition of a CTO. You would have to use guardianship.
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This is what i thought, having an argument as they are saying because he has a forensic history.
There is no authority within S.17A to convey if your pt refused to return.
Thank you for your reply
CTO conditions don’t have to be about medical treatment. Section 17B(2) of the Act says they can be imposed:
“… if the responsible clinician, with the agreement of the approved mental health professional …, thinks them necessary or appropriate for one or more of the following purposes—
(a)ensuring that the patient receives medical treatment;
(b)preventing risk of harm to the patient’s health or safety;
(c)protecting other persons.”
A condition about where the patient is to live could certainly fall within that - and is one of the examples given in chapter 29 of the (English) Code of Practice.
But, as others have said (and like most CTO conditions), it can’t be directly enforced.
This is my understanding as well - there is no power to make someone return to a place of residence - the only power is to recall to hospital. Also have to be careful that the conditions would not amount to a deprivation of liberty so cannot be overly restrictive
Yes,you can stipulate where they need to stay.
What you will find across the length and breadth of England and Wales is that AMHPs - I am one and next month represents 31 years in the role - will always advise other professionals that CTOs should not be used for conditions about where the patient should reside. CTOs are for treatment in the community. S.7 Guardianships are for maintaining someone in their residence and have legal enforcement options. Any CTO condition containing where the patient should reside can never be enforced so it is completely useless to include it. It therefore could be seen as coercion and threats to the patient in some people’s opinions, mine included!
Thank you for your response
No non-mandatory condition is enforceable, however the purpose of them and for CTOs in general, is to encourage/coerce the patient to stick to the treatment plan, or to prevent risk of harm to the patient’s health or safety, or to protect other persons. Any condition that seeks to achieve these objectives is potentially legitimate.
Discretionary conditions must be necessary or appropriate to ensure that P receives medical treatment for mental disorder and/or to prevent a risk of harm to P’s health or safety as a result of mental disorder and/or to protect other people from a similar risk of harm (MHA CoP 29.28). We suggested that conditions relating to alcohol and illicit substances should form part of P’s CTO care plan rather than be included as unenforceable conditions of the CTO”
“…most CTO1 forms contained a discretionary treatment condition stating that P “must take medication as prescribed”. We considered that this wording did not make it clear enough that medicine cannot be forced on patients who are subject to a CTO in the community, and that recall to hospital must be justified with evidence that P’s mental state has deteriorated and there is corresponding increased risk (MHA COP 29.35, 29.46 and 29.49)”.
“We found 20 CTOs with a discretionary condition that P must reside at a specified address. The therapeutic purpose of this condition was not addressed in the care plan, & we could not find justification for the restriction in the notes. We also found conditions that P must live wherever the clinical team decided. We took the view that this type of condition did not strongly show a clear purpose or have regard to the principle of the least restrictive option and maximising independence”.
Thank you for the clarification.