Supervised community treatment was one of the most controversial aspects of the 2007 Mental Health Act. The new powers were introduced in November 2008, since which time some 1,200 requests for second opinions to ratify such orders have already been made.
This figure, according to the Mental Health Act Commission, has “far exceeded expectations”. It has put such pressure on the commission’s second opinion appointed doctor service that it published an urgent call for more people to come forward to take on this function.
Such a large number of people being made subject to supervised community treatment raises some important issues. International experience, including from Scotland, suggests that community treatment orders are used sparingly at first but become more commonplace over time.
It is unclear as yet whether England and Wales are going to buck this trend with an initial rush of community treatment orders that even out over time or if the first 1,200 are just the tip of the iceberg to come.
As the government has stated many times, supervised community treatment was designed as a regime for people who are subject to frequent hospital admissions and relapses. It should not be the default method of discharging a person from detention in hospital but a specific way of supporting people who are thought to need the threat of readmission to continue to accept treatment outside hospital.
In other words, supervised community treatment is appropriate where it is genuinely the least restrictive alternative for that person, and only for as long as it remains so.
What we do not know yet is whether the 1,200 or more people who are now experiencing supervised community treatment would previously have been made to stay in hospital for longer, or if supervised community treatment is being used more broadly as a risk-averse alternative to discharge without compulsion. And we will not be able to answer for some time the crucial question of how long supervised community treatment is going to be applied to those people.
For community mental health services, meanwhile, the arrival of large numbers of people on supervised community treatment present a potential challenge regardless of why this is happening. Will people on supervised community treatment take precedence for the most intensive support from assertive outreach teams, for example? How will the newly established right to independent advocacy be made accessible and relevant to people on supervised community treatment? And how will they manage instances of people not complying with their community treatment orders?
The Care Quality Commission, which has now taken over the responsibilities of the Mental Health Act Commission, faces a major task in keeping watch over the use of supervised community treatment. The initial rush of applications for the new power raise serious questions about the preparedness of services to manage it, about the impact on the lives of those subject to it (and their carers) and about the prospects for its future use.
This is a big challenge for a new regulator, but one that will indicate whether its new enforcement powers will be sufficient to ensure no one is placed on supervised community treatment when it is not needed, nor placed under conditions they do not need, nor kept on it for longer than is necessary.