# Potential reduction in paper reviews for CTO patients **URL:** \ **Category:** Mental Health Tribunal\ **Tags:** referral, cto\ **Created:** [6 May 2025 21:47 UTC](https://forum.mentalhealthlaw.co.uk/t/potential-reduction-in-paper-reviews-for-cto-patients/3628 "2025-05-06T21:47:19Z")\ **Posts on this page:** 1\ **Showing post:** 1
**Author:** ![Jonathan](https://forum.mentalhealthlaw.co.uk/user_avatar/forum.mentalhealthlaw.co.uk/jonathan/32/88_2.png) [@Jonathan](https://forum.mentalhealthlaw.co.uk/u/Jonathan)\ **Post date:** [6 May 2025 21:47 UTC](https://forum.mentalhealthlaw.co.uk/t/potential-reduction-in-paper-reviews-for-cto-patients/3628/1 "2025-05-06T21:47:19Z")
The tribunal has been able since 2012 to hold CTO mandatory reference hearings on the papers when the patient does not wish to attend or be represented at a hearing. In 2024 a similar power to hold detention mandatory reference hearings on the papers was added and, seeing as paper hearings dilute the statutory safeguards, [rule 35](https://www.mentalhealthlaw.co.uk/Tribunal_Procedure_(First-tier_Tribunal)_(Health,_Education_and_Social_Care_Chamber)_Rules_2008#Rule_35) was changed so that paper hearings can’t be held when: > (a) the patient’s case has not previously been considered by the Tribunal, or > > (b) the patient’s case was last considered by the Tribunal without a hearing. Here are three observations/questions: 1. I only noticed tonight when writing some CPD questions that, although it used to be that CTO reference hearings could be decided on the papers every time, now that is limited to every other time. In one way it makes sense to treat both classes of patient in a non-discriminatory way, but the tribunal might not save as much money and time as it had hoped. I wonder whether the number of new detention paper hearings has been or will be greater than the reduction in CTO paper hearings. 2. I wonder what “the patient’s case” means. If it doesn’t include both detention and CTO periods then that would further reduce the ability to have paper hearings (as the first hearing on the CTO would have to be an oral hearing). 3. It used to be that capacity was only considered by the tribunal if an unrepresented patient asked for a paper hearing – but now the tribunal has to be satisfied that the patient has capacity to decide in relation not only to detention cases but also CTO cases, whether the patient is represented or not. Previously a [rule 11](https://www.mentalhealthlaw.co.uk/Tribunal_Procedure_(First-tier_Tribunal)_(Health,_Education_and_Social_Care_Chamber)_Rules_2008#Rule_11)(7)(b) representative of a CTO patient could request a paper hearing (though maybe the change is a good one). Has anyone come across any of this in practice? --- _[View the full topic](https://forum.mentalhealthlaw.co.uk/t/potential-reduction-in-paper-reviews-for-cto-patients/3628)._