Number of people with mental health problems compulsorily treated in the community may reach several thousands, warns The King's Fund

The government is likely to have underestimated the number of people with mental health problems who will be placed on community-based treatment orders if the draft Mental Health Bill 2004 becomes law, according to a new report, A Question of Numbers: The potential impact of community-based treatment orders in England and Wales, published today by The King's Fund.

The report says that over the next 10 to 15 years the number of people with mental health problems living in the community in England and Wales under community-based treatment orders may reach several thousands - not the fourteen hundred plus that the Department of Health has assumed.

However, it also challenges the claim that the Bill will open the floodgates to compulsion as some campaigners have suggested. The findings are based on evidence from international data and an analysis of how orders may be used in England and Wales.

The report suggests there is likely to be a gradual year-on-year increase in the number of people on community-based treatment orders, although there may well be significant regional variations in their use. However, at the same time, resource pressures on community services and tribunals, which will be needed to authorise compulsory treatment in the community, will act as a significant brake on the use of community-based orders.

Report author Simon Lawton-Smith said:

'The government assumption that in the first years of the new Act about 10 per cent of the total number of patients who are currently detained in hospital - about 1,450 people - will be on community-based treatment orders is not unreasonable, at least in the short term. Nevertheless, this is lower than our own expectation and we believe it under-estimates the number of people who will eventually be placed on such orders.

'We also acknowledge that proposed changes to the draft Mental Health Bill before it is tabled in Parliament, and subsequent regulations, may tighten the conditions under which orders may be imposed and lead to fewer people being subject to compulsion than we have estimated. However, there is a strong likelihood that the numbers of people placed under compulsory community treatment will increase year-on-year. This has been the experience of almost all other countries with similar systems. At the heart of this lies a real challenge for mental health service commissioners and planners who will need to be prepared to meet the extra demand on their services.'

A Question of Numbers: The potential impact of community-based treatment orders in England and Wales draws on questionnaires, interviews and a review of the published literature on the international use of community-based treatment systems. It sets out to shed light on the number of people in England and Wales who may become subject to community-based treatment orders if the draft Bill becomes law. This is a difficult and uncertain area but based on the evidence available the report suggests that the use of community-based treatment orders is likely to build up over the next 10 to 15 years to between 15 and 25 people per 100,000 population - between around 7,800 and 13,000 people.

The report examines the use of community-based treatment orders around the world and found their use varies significantly from country to country. Australia and New Zealand tended to have the highest use at around 50 people per 100,000 population, while Canada has the lowest use at around two people per 100,000 population.

The King's Fund chief executive Niall Dickson said:

'This report is cautious in its conclusions but we hope it will help inform the debate over the draft Mental Health Bill and provide a better idea of the number of people who may, over time, be placed on community-based treatment orders. It should also help those responsible for planning and commissioning services to estimate future patient needs in the community, and ensure there are adequate resources to meet them. The use of community-based treatment orders will undoubtedly have a big impact on mental health services and its workforce and the NHS will need to be prepared to deal with the extra demand on its resources.'

Although the report does not discuss in detail whether compulsory community-based treatment is effective, it points out that the research evidence is mixed. Some studies demonstrate benefits for patients, while others do not.

Niall Dickson added: 'It would appear that community-based treatment orders may benefit some people, and there is evidence of support for them both from professionals and some patients. However, I do not believe we are currently able to reach a definitive conclusion as to whether or not they would be beneficial in England and Wales.'

Read the report; A Question of Numbers: The potential impact of community-based treatment orders in England and Wales,

Notes to editors: 

1. For further information, interviews or a free copy of the report, please contact the King’s Fund media and public relations office on 020 7307 2585, or 07831 554927. An ISDN line is available for interviews on 020 7637 0185.

2. A Question of Numbers: The potential impact of community-based treatment orders in England and Wales is priced at £7.50 and is available from King’s Fund publications on 020 7307 2591. Copies of the report are free to download from Tuesday, 20 September at www.kingsfund.org.uk/publications.

3. The draft Mental Health Bill 2004 introduces community-based treatment orders in England and Wales. A community-based treatment order requires a patient to comply with a set of conditions, such as taking their medication, while allowing them to live in the community as a less restrictive alternative to hospital. These orders are particularly targeted at “revolving door” patients, who tend to have difficulty engaging with mental health services and taking their medication, leading to an exacerbation of their mental health problems and repeated hospital admissions. The draft Bill would allow tribunals to authorise treatment through an order which would specify whether the patient should be treated in hospital or treated in the community.

4. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.