Mentally ill face compulsory treatment

Community treatment orders are a response to hospital closures

Care-in-the-community patients who do not take their medication face compulsory readmission to hospital under proposals unveiled in a government Green Paper.

Under the plans, patients deemed to present a danger who are discharged from hospital could be given a compulsory care and treatment order specifying where they live and a care plan.

Social and health workers will have a duty to ensure the care plan stipulations are carried out.

Patients who disregard their plan will be returned, if necessary, forcibly, to hospital for compulsory treatment.

More secure beds and specialist crisis teams are also to be created with the aim of improving access to care.

The proposals, which cover England and Wales, are backed in England by an extra £40m for NHS mental health services and an additional £13m for local authorities for next year.

The government, which has already unveiled a £700m fund for mental health in England over the next three years, has made the sector one of three priority health areas.

The Green Paper proposals follow recommendations by experts, agreed by the government, for the setting-up of quasi-judicial tribunals for the approval of compulsory care and treatment orders (CCTOs) and longer term assessments.

The government says the expert review, the first extensive review since the 1950s, has to be seen in the context of its national service framework for the mentally ill and other policy initiatives.

The proposals, which also include restrictions on electro-convulsive therapy, a right to an independent review of compulsory treatment orders at which the patient can be present and clearer assessments of patients, will extend treatment to a community setting.

They follow concerns about a number of high-profile killings by community care patients.

Health Minister John Hutton told the BBC that the current system had failed to provide proper care in the community for the most severely mentally ill.

He said: "The present system of care in the community has actually become couldn't care less in the community.

"There are very severely mentally ill patients who do need to comply with their treatment programmes, but who are allowed under the present system to drift out of contact with services and the results can be tragic.

"We cannot sit back any longer, recognising that there are problems with the legislation, recognising that patients, the public and staff are at risk and do nothing about it at all.

"What we want is appropriate care in the right setting which can meet the needs of the patient and the community as a whole."

Mixed reaction

Mental health, disability and health organisations have given a mixed response to the proposals.

The National Schizophrenia Fellowship is one of a number of groups handing in a petition to the government on Tuesday, saying the reforms should concentrate on patients' rights rather than compulsion.

It says the proposals represent "a missed opportunity".

Others, like Mind, say compulsory treatment orders may stop people coming forward for treatment.

But the Zito Trust says the reforms represent a much needed modernisation of legislation, reflecting the changeover from hospital to community treatment of the mentally ill.

The proposals are now out for consultation until 31 March 2000.