Concerns have been raised about how Community Treatment Orders (CTOs) forcing mental health patients to take their medication are being served and carried out.

The Care Quality Commission (CQC) has found that ten times as many orders as expected, an average of 367 a month, have been applied since their introduction In November 2008.

In a finding that the report’s main author Mat Kinton told HSJ was “very worrying” black and minority ethnic (BME) mental health patients are also being disproportionately subjected to the orders.

“We are concerned that there are more patients from some of the BME groups placed on a CTO compared to the proportions among detained patients, where there is already BME over-representation in relation to the wider community,” he said.

In a sample of patients under the orders 30 per cent had no history of refusing to take their medication or co-operating with community services suggesting that about a third of orders are wrongly being used as a preventative measure.

CQC said this suggests that some hospitals are “playing safe” by putting patients on an order, and it could be one of the reasons for the higher than expected use of CTOs.

Mr Kinton told HSJ that in some cases that CTOs bred “complacency” as hospitals felt that as long as a patient was being forced to take their medication their duty of care was at an end.

“The very worse examples we have seen is where people come into a clinic once a month to pick up their pills or get a jab and that is the entire extent of the engagement with them, they are effectively being dumped in the community,” he said.

The study also found that 35 per cent of the sample were prescribed medication above the limits recommended by the British National Formulary. “While for some patients there can be legitimate reasons for this, each case needs to be reviewed regularly to ensure that it remains appropriate, and that the patient has the opportunity to discuss any concerns about side-effects and receive basic health monitoring,” the report said.

The commission’s chief executive Cynthia Bower said: “We have found too much poor and unacceptable practice and this must be tackled. Our top priority is to protect the interests of patients, and we will use our powers to ensure that care providers address these issues and make real improvements.”

CQC is calling for more research the issues raised by the study.

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