Whether to use Form CTO12

Law and practice Mental Health Act
1

Pt discharged on a CTO as a trade off that P will take depot.

(History of noncompliance)

after 3 weeks if discharged she takes depot

but during capacity to consent 4B assessment says wants lower dose.

P reluctantly agrees to take the higher prescribed dose after reminding the mandatory conditions.

On a balance P has capacity which can fluctuate but dislikes side effects which are not significant and did nit wish to continue with assessment .

Insight and capacity cant be equated but P’s insight Re diagnosis may be impaired but capacity re meds appears to be preserved.

Is it ok if RC fills CT012 form

2

Capacity is always only related to the specific issue, never overall.
So here the issue is ‘does (s)he understand they are considering a cto.’. Consent is not the issue

3

I am not in position to agree or disagree. I’m not talking about you. Therefore I am not ‘saying’ you won’t act properly.

Insight is not equivalent to capacity - agreed. However, if the nature and/or degree of lack of insight impairs abilities to understand, retain and weight information in the balance (including issues related to materiality - Montgomery 2015 UKSC), then in some cases I have found it relevant to capacity assessments.

I have three such cases right now. They’re all on T3s and will remain on T3s. In other words serious lack of insight can become a wall to receiving, retaining information (can’t retain what was never received) and weighing in the balance e.g. [Fictional] “It’s not me. The whole lot of you are mad. I’m from and alternate 8-dimensional existence. I’ve been sent here through a portal to wage war against evil in your 4-dimensnional world and you want to lock me up and stuff me with your primitive chemicals. You know nothing. You just don’t understand what’s going on - you cannot grasp higher dimensional concepts. Be gone! I’m not listening you - you puny creatures.”

It’s always ok to fill out a form. But not okay if the underlying documented evidence of statutory compliance is not to be seen or understood by anyone else.

Forms are one of the biggest national fudges in mental health services, based on my observations over the years.

The CTO12 form requires,“.. I certify that this patient has the capacity/is competent to consent (delete the one that is not appropriate) and has consented to the following treatment.”

Capacity is always about specific decisions or closely related items of decisions in a particular nexus.

Nobody is going to know if ‘a AC’ considered the component issues across the legal tests. Why? Because nobody really scrutinises these things with a legal eye.

But my observations and opinions are not confined to CTO12 forms. I regularly see the absence of documentary evidence and thought underlying Med Recs forms, H5 forms, S61 forms, S62(1) forms, S17 forms, and even some T3 forms. Peers singing from the same cultural hymn sheet will say ‘good job’.

I declare that I have worked in all the wrong places, therefore my observations cannot be extrapolated to the ‘national scene’.

4

yes agree , but this is specifically to do with capacity to consent to treatment Part 4B of MHA ie if P has the capacity to consent to the Depot. IF P has capacity RC fills CT012 , but if P lacks capacity to consent for depot need a SOAD to certify CT011 form. P lacks insight into illness ( psychosis), is in remission . No thought disorder, no delusions that interfere with the functional limb to consent. Personal values are that P dislikes meds and side-effects so wants lower doses with eventually would like to come off depot . lower doses lead to relapses. last time, RC went by her wishes and this led to a relapse. question is P lacks insight into their psychosis , is now in remission, was reluctant to take the dose prescribed ( Is this objection?) but when reminded of CTO conditions reluctantly agreed . SO should RC sign CTO 12 ie has capacity