Who can place a patient on CTO?

Only the current RC ( along with the AMHP) can place a patient on CTO. This would mean that the inpatient RC ( and NOT the community RC who will take over the patient after discharge) has to complete the CTO. Is this right? Can community RC place the patient on CTO?

There is no such thing as a community RC or inpatient RC, it is whoever the RC is at the time, which should be determined in accordance with local policy.

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Patients who are being placed on CTO are usually in-patients on the ward. The in-patient consultant puts them on CTO and care is then taken over by the community RC.

Every detained patient has an RC who is responsible for the overall care. In inpatient units, it is usually the inpatient consultant ( or other professionals who deliver RC role). When such patients are placed on CTO, the law states ’ the CURRENT RC’ is to complete the CTO1. Can another RC ( ie a consultant in community who is taking over the CTO after discharge from the ward) place the patient on CTO by completing the above forms?

No.Patient has to be on section 3,inpatient & at time of discharge CTO.

If a patient is placed on CTO by any RC other than current RC, ( in this case, a consultant in community instead of the RC in charge of inpatient care) would the CTO be valid ?

That’s not entirely correct, the person does not have to be an inpatient; the person must be liable to be detained under i.e. section 3, but could actually be on leave somewhere.

There is no other RC, there can only be one! This confusion is caused by the notion that there are community and inpatient RCs; they don’t exist. There is one RC who may be an inpatient and/or community Approved Clinician.

You need to take a Zen-like approach and decide who was the RC at the time the CTO was imposed. Don’t worry about where they worked, just focus on the moment of signature- was the AC who signed the form the patient’s RC at that moment?
Part 1 of the CTO1 form starts by saying ‘I am the Responsible Clinician’. If the person completing the form was not the RC then they should not have signed a form saying they are.

Is this Community RC covering the Inpatient RC ?

That is right.

Only the RC of the (section 3 detained patient in a hospital) can complete the CTO1. The controversy with policy followed by some trusts is that community consultants who are not the RC of these patients ( while on section3 and detained in hospital and under care of inpatient consultant) are asked to complete the CTO1. I consider this as against the law. RC of a section3 patient is the AC who has overall responsibility. Almost always this is the inpatient consultant. What can you do when you are asked to complete CTO1 in such situation?

I agree that all detained patients would have an identified RC. Usually this is the inpatient consultant ( or MHPs with AC status who has overall responsibility for the care of this patient ). In such a situation, can any one else ( like a consultant in community team who will be the responsible clinician AFTER discharge of this patient to the community ) take the current RC role and complete the CTO 1?

Yes they can- see chapter 36 of the Code of Practice which is all about allocating and changing the RC. As Guy has already said- there should be a local policy clarifying how the Code’s guidace will be implemented and how everyone is clear about who is the RC at any time.

No. There is mo arrangement like that in this case.